MEDizzy - A 55-year-old patient presents to you after a 3-day hospital

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Cardiology

A 55-year-old patient presents to you after a 3-day hospital stay for gradually begin digoxin plus furosemide on a scheduled basis. increasing shortness of breath and leg swelling while away on a business trip. He was told that he had congestive heart failure, but is asymptomatic now, with normal vital signs and physical examination. An echocardiogram shows an estimated ejection fraction of 38%. The patient likes to keep medications to a minimum. He is currently on aspirin and simvastatin. Which would be the most appropriate additional treatment?

ExplanationAngiotensin-converting enzyme inhibitors have been shown to prevent or retard the development of heart failure (HF) in patients with left ventricular dysfunction and to reduce long-term mortality when begun shortly after an MI. They play a central role in heart failure management. An angiotensin II receptor blocker may be substituted. Beta-blockers are typically the next addition, with evidence of fewer rehospitalizations for HF and future cardiac events. Loop or thiazide diuretics are administered to those with fluid accumulation. The aldosterone antagonist spironolactone is indicated in more advanced (NYHA III or IV) heart failure. Digoxin is reserved for those with symptomatic systolic dysfunction, especially with atrial flutter or fibrillation and rapid ventricular response. Nitrates relieve symptoms of angina but do not prolong survival or prevent hospitalization in patients with HF. General therapeutic measures include salt restriction and regular moderate exercise. Patient preferences are important to consider but should not keep you from giving your best medical recommendation, which the patient can then decide to accept or not.