73year old with heart failure with reduced Ejection fraction

73 year old man presented with the complaints of
Dragging pain in the left inguinal region since 2 months

Patient was admitted under general surgery for left inguinal hernia and left varicocele.

Patient was eventually taken up by us in view of ecg changes.
Ecg shows Lbbb along with increased PR interval (240msec)
2decho was done which showed heart failure with reduced Ejection fraction 35% with LAD akinesia and hypokinesia of RCA and LCX territory

However the patient gives no complaints of Dyspnea, chest pain, giddiness, orthopnea and PND. 
He gives a history of getting operated for? Right inguinal hernia 10 years back 
 He had no previous complaints of chest pain, Dyspnea, orthopnea, PND but was told to have a heart problem and had to undergo CAG on routine investigations
CAG was done 7 years back ( no documentation available).
On examination:
PR - 78bpm
Bp - 100/70mmhg
Afebrile
Jvp - not raised
Cvs:
Apex beat in left ICS, 1cm lateral to MCL
S1, S2+
Lungs - clear on auscultation
Per Abdomen -
Soft
Bowel sounds +


 DIAGNOSIS:HFrEF (EF 35%) secondary to ischemic heart disease 
Left inguinal hernia with left varicocele.

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