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Cardiac resynchronization therapy (CRT) has been an important adjunct to goal directed medical therapy in heart failure patients who qualify for this device. Too often, when heart failure patients complain about severe fatigue, beta-blockers are immediately reduced. Personalization of settings, verified by noninvasive hemodynamics, can allow for maximizing medical therapy. A newly diagnosed 40 year-old male presented to the heart failure clinic post hospital discharge with a severely dilated, non-ischemic cardiomyopathy. Even with an ejec