Hello. Thank you for your question and welcome to HCM. I understand your concern. There is clearly a deteriorating function of the heart at this patient. Now, ıt means that the heart pumps only 30% of its content during one systole. This can cause two types of problems: first, the contained blood at 70% raises the pressures for upper chambers to empty their content to the left ventricle through the diastole (relaxation phase) and all the upper floors suffer from this raised pressure; second, this heart is insufficient, so it pumps only 30% of its content, and this is not sufficient for end-organs to get enough oxygen and nutrients by the blood. This case should be carefully treated and watched. Besides other classes of drugs used to treat ischemic heart disease, a key role is given to diuretics, such as furosemide. Furosemide tends to lower the potassium levels and the fraction ejection under 35%, warrants adding spironolactone to the therapy, which is proven beneficial and also has potassium keeping properties. The diet should be very low on salt, no salt at all would be better, since salt retains large amoounts of water. This can decompensate the state of the patient in the scenario of an insufficient heart. Also, it is reasonable for him to withhold moderate to strenuous physical activity. Since the heart is dilated, it becomes an important subject to ventricular arrhythmias, which are potentially life-threatening. Therefore, I suggest you to discuss with yur cardiologist, the possibility of an implantable cardioverter-defibrilator (ICD) or of cardiac resynchronization therapy (CRT). I hope I was helpful with my answer. Take care. Kind regards, Dr. Meriton