Contraception in patients with heart failure.

Case Presentation: A 21-year-old woman presented for evaluation and management of heart failure resulting from a familial nondilated cardiomyopathy. A screening echocardiogram demonstrated a left ventricular ejection fraction of 30% to 35% with normal wall thicknesses, chamber sizes, and valvular function. On stress testing, she had good exertional tolerance and contractile reserve, but frequent premature atrial contractions and premature ventricular contractions. She was placed on carvedilol and lisinopril and has not required a diuretic. She was grava 0/para 0, using an etonogestrol/estradiol vaginal ring for contraception, and relayed to us that the nurse practitioner providing her general care questioned the safety of this for her.