Question

62 yo man with HTN and HF has dyspnea on exertion on enalapril, carvedilol, spironolactone, and furosemide with normal BP and HR. EF 35% and BNP 250. Current American Heart Association guidelines recommend which of the following to further reduce morbidity and mortality?

Answer 1

The AHA guidelines would suggest considering an SGLT2 inhibitor or a neprilysin inhibitor with an ARB for a patient with HF and reduced EF already on optimal therapy, while monitoring for potential complications.

Step-by-step explanation:

A 62-year-old man with hypertension (HTN) and heart failure (HF), who is experiencing dyspnea on exertion, is currently on enalapril, carvedilol, spironolactone, and furosemide, with normal blood pressure and heart rate.

With an ejection fraction (EF) of 35% and B-type natriuretic peptide (BNP) of 250, the current American Heart Association guidelines would likely recommend the addition of a sodium-glucose cotransporter 2 (SGLT2) inhibitor or a neprilysin inhibitor in combination with an angiotensin receptor blocker (ARB).

These newer classes of medications have been shown to further reduce morbidity and mortality in patients with chronic heart failure with reduced ejection fraction (HFrEF).

Furthermore, it is vital to ensure that the patient is on optimal doses of the current medications and to consider lifestyle modifications and device therapy as indicated.

Lastly, it's important to monitor for signs of medication overprescription, such as bradycardia or low blood pressure, as these can lead to potential complications.