### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I am a hypotropic cardiomyoptia patient with Angina, AF (lots of ER trips) recently my meds have been changed 1. Amiodarone hydrocloride added to control AF prescribed by AF doctor. The nex step if this doesnt work is putting a quarter size coin in my heart. However I am currently taking riveroxaban 20mg. It is my understanding that one of these meds would preclude surgery (i.e. coin in heart ) due to the fact that it stays in the blood stream for up to two years. So may need heart surgery but AF has me on an anticoagulane? This is all through the Heart Science Centre, London, Ontario. Any suggestions?

### output:

Hello, Lets individually ad Chat Doctor.  1) in hypertrophic cardiomyopathy, the angina is due to increased muscle mass leading to imbalance in oxygen demand and supply. Secondly due to continued existing coronary artery disease.  So here increase dose of beta blocker to max tolerating dose (would help in AF as well), add diisopyramide after beta blockers If you are above 40 check for coronary artery disease and treat like wise 2) about atrial fibrillation.  You are on rivoraxabn for anticoagulation so a blood clot doesn't form in the heart.  However, you may be put on alternative meds for that and a coin machine (a cardioverter / defibrillator) to prevent sudden cardiac death can be planned, no need to wait for 2 years for the same. 3) the heart surgery depends on the gradient, also atrial fibrillation may persist even after surgery, more likely if left atrial volume is increased If you can send me all the reports and meds you are taking, I would be able to help you further Regards 