Medicine test
A 65-year-old Caucasian female with a history of DM, HTN, and a large anterior wall MI 5 years ago presents to the clinic complaining of shortness of breath. At baseline the patient finds it difficult to do any household chores. She has shortness of breath at rest and is homebound because of her symptoms. Vital signs are: Temperature = 98.7°F, HR = 62, RR = 19, BP = 160/85 mm Hg, oxygen saturation = 90% on room air. There are bibasilar crackles with scattered expiratory wheezes. There is also 2+ pitting edema of the lower extremities. JVP is measured just above the clavicle. An ECG reveals left ventricular hypertrophy (LVH), with Q waves and T-wave inversions in V1 to V4 and diffuse nonspecific ST segment abnormalities. A CXR shows cardiomegaly and considerable congestion of the pulmonary vasculature. Prior echocardiogram obtained 1 year prior shows EF 30% with wall motion abnormalities. Labs are normal including CBC, Cr, K. The patient’s medications include losartan, carvedilol, and aspirin. What is the most important long-term intervention for this patient?
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