Cardiac Dyssynchrony as A Component of Decompensation in Chronic Heart Failure In The Presence Of Multiple Comorbidities: A Clinical Case

This paper presents a clinical case of a female patient with chronic heart failure with reduced ejection fraction (HFrEF, LVEF 28%) caused by ischemic cardiomyopathy and complete left bundle branch block (LBBB). The clinical course was complicated by arrhythmias, hypothyroidism, arterial hypertension, and signs of systemic congestion. Despite pronounced polymorbidity, temporary clinical stabilization was achieved using comprehensive guideline-directed medical therapy, including sacubitril/valsartan, β-blockers, mineralocorticoid receptor antagonists (MRAs), and SGLT2 inhibitors. The patient objectively met all established criteria for cardiac resynchronization therapy (CRT). This case highlights the importance of a personalized, multidisciplinary approach and timely consideration of invasive treatment strategies. It also illustrates the complexity of managing chronic heart failure in patients with multiple comorbid conditions.