Non-Ischemic Dilated Cardiomyopathy with Severe LVEF Reduction - AHF Clinic

Non-Ischemic Dilated Cardiomyopathy With Severe LVEF Reduction (HFrEF)

Dr. S. A. Merchant | Advanced Heart Failure Clinic in Mumbai

Patient Profile

Name	Mohd. Wasim Shaikh
Age	41 years
Gender	Male
Occupation	Employee, BPO
Presenting Complaints	Breathlessness, orthopnea, frailty, tiredness, coughing
Diagnostic Workup	2D-Echo, CPET, Cardiac MRI, CT-Coronary Angiography, NT-proBNP, 5-Day External Loop Recorder, Right Heart Catheterization
Diagnosis	Non-Ischemic Dilated Cardiomyopathy, HFrEF (LVEF 15%), Hypothyroidism, Hypotension, Ventricular Ectopy (11,866 counts)
Status at Presentation	NYHA Class III
Treatment	ICD Implantation, Guideline-Directed Medical Therapy (GDMT), listing for Heart Transplantation
Outcome	NYHA Class improved from Class III to Class II; advised Heart Transplantation

Patient details shared for this case study; identity referred to by name as provided for the record.

The Problem

Condition

Mr. Shaikh, a 41-year-old male employed in a BPO, presented with breathlessness, orthopnea, frailty, tiredness, and coughing. He was evaluated at the Advanced Heart Failure Clinic by Dr. S. A. Merchant, and a structured diagnostic workup was undertaken to establish the cause of his symptoms.
The workup, comprising 2D-Echocardiography, Cardiopulmonary Exercise Testing (CPET), Cardiac MRI, CT-Coronary Angiography, NT-proBNP, a 5-day External Loop Recorder, and Right Heart Catheterization, established a diagnosis of Non-Ischemic Dilated Cardiomyopathy with Heart Failure with reduced Ejection Fraction (HFrEF), an LVEF of 15%, hypothyroidism, hypotension, and a significant burden of ventricular ectopy (11,866 counts).
Non-ischemic dilated cardiomyopathy is a condition in which the left ventricle, the heart’s main pumping chamber, becomes enlarged and weakened without any blockage in the coronary arteries being the cause. An LVEF of 15% represents a severe reduction in the heart’s pumping capacity, and at presentation Mr. Shaikh’s functional status corresponded to NYHA Class III.

Consultation and Treatment Plan

Why a Combined Approach Was Chosen?

Rather than relying on medical therapy alone, Dr. S. A. Merchant planned a combined approach addressing the immediate risk of life-threatening arrhythmia and the long-term management of severely reduced heart function together. This included ICD implantation, listing for Heart Transplantation, and a personalized heart failure treatment plan built around Guideline-Directed Medical Therapy (GDMT).
This combination reflects a standard approach in advanced and critical heart failure care, where device therapy, transplant listing, and optimized pharmacological management each address a different aspect of the patient’s condition — arrhythmia risk, disease severity, and hormonal status, respectively — while the patient continues active treatment.

Procedure Details

Overview

Mr. Shaikh’s management combined ICD implantation with Guideline-Directed Medical Therapy, alongside listing for Heart Transplantation.

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Approach:

Device implantation (ICD) combined with pharmacological Guideline-Directed Medical Therapy, alongside transplant-listing evaluation

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Systems addressed:

Cardiac rhythm (ventricular ectopy) and ventricular pumping function (severely reduced LVEF)

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Associated finding:

Hypothyroidism, hypotension

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Cardiologist:

Dr. S. A. Merchant

ICD Implantation

An Implantable Cardioverter-Defibrillator (ICD) is a device placed under the skin, with leads positioned in the heart, that monitors heart rhythm and can deliver a corrective shock if a life-threatening arrhythmia occurs. It was advised for Mr. Shaikh in view of the severely reduced LVEF and the ventricular ectopy detected on rhythm monitoring.

Guideline-Directed Medical Therapy

Alongside device therapy, Mr. Shaikh was started on GDMT with the following add-on medications:
Vericiguat 5 mg OD — a soluble guanylate cyclase stimulator used in chronic heart failure
Amiodarone 100 mg BID — an anti-arrhythmic medication used to manage ventricular ectopy
Levothyroxine 75 mcg OD — used to manage the concurrently diagnosed hypothyroidism

Listing for Heart Transplantation

Given the severity of the ventricular dysfunction, Mr. Shaikh was listed for Heart Transplantation. This step is generally pursued alongside, rather than in place of, ongoing medical management, so that the patient continues to be actively treated while awaiting transplantation.

Post-Treatment Results

Following ICD implantation and initiation of GDMT, Mr. Shaikh’s NYHA functional class improved from Class III to Class II. He continues to be advised for Heart Transplantation as the definitive long-term treatment.

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Functional status

NYHA Class improved from Class III to Class II

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Rhythm management

ICD implanted for arrhythmia protection

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Long-term expectation

Improvement in quality of life following Heart Transplantation, with an expected survival of 15 years

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Transplant status

Advised and listed for Heart Transplantation

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Patient satisfaction

Satisfied with medical therapy

Patient Feedback

Mr. Shaikh reported being satisfied with his medical therapy.

Profile: Mohd. Wasim Shaikh · Male · 41 years · Employee, BPO Management: ICD Implantation · Guideline-Directed Medical Therapy · Heart Transplant Listing Cardiologist: Dr. S. A. Merchant, Advanced Heart Failure Clinic, Bandra West, Mumbai

Frequently Asked Questions

Q1. What is non-ischemic dilated cardiomyopathy?

It is a condition in which the heart’s main pumping chamber becomes enlarged and weakened, without any blockage in the coronary arteries being the cause.

Q2. What does an LVEF of 15% indicate?

It indicates a severe reduction in the heart’s pumping capacity, generally requiring a combination of device therapy and medical management.

Q3. Why was an ICD implanted in this patient?

It was advised in view of the severely reduced ejection fraction and the ventricular ectopy detected on rhythm monitoring.

Q4. Why was the patient listed for heart transplantation while also on medical therapy?

Transplant listing and Guideline-Directed Medical Therapy are generally pursued together in advanced heart failure, so the patient continues active treatment while awaiting transplantation.

Q5. What was the outcome for this patient?

The patient’s NYHA functional class improved from Class III to Class II, and he continues to be advised for Heart Transplantation.

Q6. Why choose Dr. S. A. Merchant?

He is an Advanced Heart Failure specialist in Mumbai, with a focus on device therapy, guideline-directed medical management, and heart transplant evaluation for patients with severely reduced ejection fraction.

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Disclaimer:The information on this page is for general informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Individual results vary from patient to patient. Always consult a qualified cardiologist regarding any medical condition.