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

### input:
my dad recently was stung by a bee on the ear.  He did have some swelling from the ear to below this chin (neck area). 24 hours latter he was in the ER and they were treating him for symptoms of CHF.  His ejection fraction was 35%.  The ER couldnt believe he had never been diagnosed with CHF because of this (and his doctor has always told him all was good).  In 2008 we checked a previous test and it was at 65%.  In 2011 in the hospital was the next test which showed 35%.  During this time his doctor also had him taking avandia and it took us confronting this doctor before he agreed to change meds (his comments were his heart was fine and the avandia wasnt an issue). With all this info, do you think that the bee sting could have caused symtoms of CHF or the avandia could have change the ejection fraction?  He will be seeing a specialist in July so I am trying to get info to review during this visit

### output:

Hi as per your query bee sting has nothing to do with congestive heart ailurethere are a number of causes of CHF, in most of the people it takes many years for the EF to lower from 60% to 35%, but there are diseases like cardiomyopathiesavandia (rosiglitatzone) has been banned in the market because it has serious side effects like causing a heart attack and precipitating CHF...this rapid decoration of your father LV functions can be because of rosiglitazoneif there are no findings of any particular cardiac disease in his echo, it can be a CHF caused by rosiglitazoneif echo reports of your father showed some regional wall motion abnormality then another possibility is that your father got a silent heart attack(as a side effect of rosiglitazone) (in diabetic due to neuropathy many times' chest pain is not there), so as the heart attack passé UN noticed his ejection fraction decreased by time till the time you see a specialist tab lasilactone 50 mg once daily tab circa(carvedilol) 3.125 mg twice daily tab Candace (April) 2.5 mg once daily tab flatiron Mr 35 mg(trimetazidine increases the ejection fraction) should be given