Q. A 35-year-old woman, gravida 0, para 0 comes to the office with her husband for a preconception visit. They have been trying to conceive for the past 2 months with no success. Past medical history is significant for a myocardial infarction in her 20s from the use of cocaine. As a result, she now has left heart failure with a left ventricular ejection fraction of 25%, which is being managed by her cardiologist. The patient denies the use of tobacco and illicit drugs as she stated that she stopped using cocaine after suffering the myocardial infarction. She consumes alcohol socially on weekends. Blood pressure is 125/70 mmHg and pulse 75/min. Which of the following would be a contraindication to pregnancy?