Thank you all for the helpful replies. I was a bit in shock/denial yesterday which is not my norm. The ECHO was done in December when my Internist heard a murmur. That first cardiologist who only reviewed the ECHO and sent to my INternist is who said EF 50% . Then I had an appt yesterday with a different Cardiologist who said more like 45-50%. He also did an ecg which shows left axis deviation and he said said right chamber is dialated. He ordered the CT to rule out ischemic cardiomyopathy. I am asking for another cardiologist referral for a 3rd opinion. I'll be honest--I don't want to start meds yet, is that crazy? As I mentioned, I am healthy weight/thin but already take thyroid medicine, metformin, b12 injections (deficiency from 25 years on metformin). I do jog/walk daily--but am now trying to finally add some strength training with light weights. I want to try that plus Coq10 and omega 3, and maybe re-do ECHO in 6 months? I know you're not my Dr but just wondering any advice. Yes, I have strong family history of CHF but I have a healthy lifestyle. Is RF at 45-50% really suggestive of meds? He prescribed 25 mg toprol and 10 mg jardiance. Thanks