Hi, In your mother s case the heart pumping of 35% (which is evaluated by doing echocardiography as Left ventricular ejection fraction, LVEF) is mostly likely to be due to old heart attack which she is not aware of. In heart attack some part of muscles of heart (myocardium of left ventricle) get permanently damaged due to lack of blood supply to that part of heart. This damage depend upon time duration of symptoms of heart attack and treatment received, and also on type of treatment received. Some patients do not aware of symptoms of heart attack or neglect it and miss the symptoms as in your mother s case (this happen more in diabetic patients), these patient do not receive medical attention and due to lack of medications there is likely possibility of further deterioration of heart function (pumping). Though there are other possible causes of decreased heart pumping like infection, high blood pressure, diabetes in these case there is possibility of improved heart pumping after tratment. As you have been told that your mother had heart attack in the past by your doctor, this consideration must be based on echocardiography report. So there is really less chance of improvement in heart pumping in your mother, but we can definitely try to maintain current heart pumping by appropriate treatment. We can do following for your mother (depending on her current infection, her physical activity and tolerance) 1) To start her on blood thinning medicine (antiplatelets) 2) Control her blood pressure, diabetes, cholesterol if problem present. 3) Coronary angiography which will tell about degree and number of blockages in different blood vessels of heart depending on which we can plan further management. 4) Start her on diuretics, b blockers, ACEI/ARBs, only if tolerated in current senario.