Dilated Cardiomyopathy With Severely Reduced LVEF (20%) and Heart Transplant Listing
Dr. S. A. Merchant | Advanced Heart Failure Clinic in Mumbai
Patient Profile
| Name | Dr. Jyoti Sharma |
| Age | 39 years |
| Gender | Female |
| Occupation | MD Pathologist, Lal Path Lab |
| Presenting Concern | Persistent NYHA Class III or IV symptoms despite Guideline-Directed Medical Therapy (GDMT); unable to tolerate Vericiguat due to hypotension |
| Diagnostic Workup | 2D-Echo, Cardiac MRI, NT-proBNP (raised) |
| Diagnosis | Dilated Cardiomyopathy, LVEF 20% |
| Treatment | Continued GDMT, fluid restriction, listing for Heart Transplantation |
| Current Status | On GDMT; listed for Heart Transplantation |
The Problem
Condition
Dr. Jyoti Sharma, a 39-year-old female working as an MD Pathologist at Lal Path Lab, was under the care of Dr. S. A. Merchant at the Advanced Heart Failure Clinic. Despite being on Guideline-Directed Medical Therapy (GDMT), she continued to have symptoms corresponding to NYHA Class III or IV. Vericiguat, one of the add-on heart failure medications, could not be continued because she was unable to tolerate it due to hypotension.
The diagnostic workup consisted of 2D-Echocardiography, Cardiac MRI, and NT-proBNP measurement. Together, these established a diagnosis of dilated cardiomyopathy with a Left Ventricular Ejection Fraction (LVEF) of 20%, along with a raised NT-proBNP level.
Dilated cardiomyopathy is a condition in which the left ventricle, the heart’s main pumping chamber, becomes enlarged and weakened, reducing its ability to pump blood effectively. The ejection fraction is the percentage of blood pumped out of the left ventricle with each contraction, and an LVEF of 20% represents a severe reduction in pumping capacity.
Understanding the Findings
Each investigation contributes a different piece of information in advanced heart failure evaluation. 2D-Echocardiography provides an assessment of chamber size, wall motion, and ejection fraction. Cardiac MRI offers a detailed characterization of the heart muscle. NT-proBNP is a blood biomarker released in response to stretch of the heart’s chambers, and raised levels are associated with heart failure.
The NYHA (New York Heart Association) classification grades functional limitation. In Class III, physical activity is markedly limited although the patient is comfortable at rest. In Class IV, symptoms are present even at rest. Persistence of Class III or IV symptoms despite optimized medical therapy is one of the indicators of advanced heart failure.
Consultation and Treatment Plan
Why This Approach Was Chosen
In patients whose symptoms persist despite GDMT, the available options depend on how the individual has responded to, and tolerated, each medication. In Dr. Sharma’s case, symptoms continued at NYHA Class III or IV, and hypotension limited the use of Vericiguat. Hypotension is a recognized factor that can restrict the use or dose of heart failure medications.
Dr. S. A. Merchant therefore advised fluid restriction alongside continued GDMT, and advised Heart Transplantation. This approach keeps the patient on active medical treatment while the definitive long-term option is pursued.
Procedure Details
Overview
Dr. Sharma’s management at this stage consists of continued GDMT, fluid restriction, and listing for Heart Transplantation.
Approach:
Systems addressed:
Associated finding:
Cardiologist:
Guideline-Directed Medical Therapy
GDMT refers to the combination of medications recommended by clinical guidelines for heart failure with reduced ejection fraction. The aim is to reduce symptoms and the risk of worsening heart failure. The regimen is individualized, since tolerance varies between patients and blood pressure often influences which medications can be used and at what dose.
Vericiguat is a soluble guanylate cyclase stimulator used in chronic heart failure. Because it can lower blood pressure, it was not tolerated by Dr. Sharma, who had hypotension. She continues on the remainder of her GDMT.
Fluid Restriction
Fluid restriction is a general measure in heart failure management. Limiting fluid intake helps reduce the accumulation of fluid in the body, which can worsen breathlessness and swelling. The extent of restriction is individualized by the treating cardiologist based on the patient’s clinical status.
Listing for Heart Transplantation
Heart Transplantation is considered in advanced heart failure when symptoms and ventricular dysfunction remain severe despite optimized medical therapy. Listing is generally pursued alongside, rather than in place of, ongoing medical management, so that the patient continues to be actively treated while awaiting transplantation. Dr. Sharma has been listed for Heart Transplantation.
Post-Treatment Results
Dr. Sharma is currently on GDMT and is listed for Heart Transplantation. Her care continues under Dr. S. A. Merchant at the Advanced Heart Failure Clinic.
Current medical therapy
Long-term expectation
Transplant status
Patient satisfaction
What to Expect After Heart Transplantation
The expected long-term outcome for this patient is improved clinical outcomes and a better quality of life following Heart Transplantation. In general, patients who undergo transplantation require regular follow-up and lifelong medical care after the procedure, which is coordinated by the transplant team.
Patient Feedback
Dr. Sharma reported being satisfied with her care.
Profile: Dr. Jyoti Sharma · Female · 39 years · MD Pathologist Management: Guideline-Directed Medical Therapy · Fluid Restriction · Heart Transplant Listing Cardiologist: Dr. S. A. Merchant, Advanced Heart Failure Clinic, Bandra West, Mumbai
Frequently Asked Questions
Q1. What is dilated cardiomyopathy?
Q2. What does an LVEF of 20% indicate?
Q3. Why was Vericiguat not continued in this patient?
Q4. Why is fluid restriction advised in heart failure?
Q5. Why was the patient listed for heart transplantation while on medical therapy?
Q6. Why choose Dr. S. A. Merchant?
He is an Advanced Heart Failure specialist in Mumbai, with a focus on guideline-directed medical management, device therapy, and heart transplant evaluation for patients with severely reduced ejection fraction.
Living With Persistent Heart Failure Symptoms?
A consultation at the Advanced Heart Failure Clinic in Mumbai gives you the chance to understand your condition and which treatment options are realistic for you.
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.