A 72-year-old man with a history of chronic heart failure secondary to ischaemic cardiomyopathy is reviewed. He was discharged two weeks ago from hospital following a myocardial infarction. An echocardiogram done during his admission showed a left ventricular ejection fraction of 40% but did not demonstrate any valvular problems.
Despite his current treatment with furosemide, ramipril, carvedilol, aspirin and simvastatin he remains short of breath on minimal exertion such as walking 30 metres. On examination his chest is clear and there is minimal peripheral oedema.
What is the most appropriate next step in managemen t?
A.A Stop aspirin
B.A Refer for cardiac resynchronisation therapy
C.A Switch carvedilol to bisoprolol
D.A Add angiotensin-2 receptor blocker
E.A Add an aldosterone antagonist***
Despite his current treatment with furosemide, ramipril, carvedilol, aspirin and simvastatin he remains short of breath on minimal exertion such as walking 30 metres. On examination his chest is clear and there is minimal peripheral oedema.
What is the most appropriate next step in managemen t?
A.A Stop aspirin
B.A Refer for cardiac resynchronisation therapy
C.A Switch carvedilol to bisoprolol
D.A Add angiotensin-2 receptor blocker
E.A Add an aldosterone antagonist***
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cardiology