Advanced HF due to HCM is defined as LVEF < 50% and should be treated according to the general principles of treatment of patients with HF and reduced ejection fraction that are based on beta-blockers, ACE inhibitors/ARB/angiotensin receptor/neprilysin inhibitors, mineralocorticoid receptor antagonists and SGLT2i [1, 17, 140]. The gene discussed is ACE; the disease is hydrops fetalis.