A 50-year-old African American woman presents to clinic feeling tired for the last 3 months. She also has trouble breathing when walking 2-3 blocks. She sleeps on 2 pillows at night to help with her breathing. PMH: HTN, arthritis. Physical exam: edema present in both feet. Medications:
- HCTZ 12.5mg daily,
- verapamil SA 120 mg daily,
- ibuprofen 200 mg BID for arthritis in knee.
Vitals:
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- Weight 63kg,
- BP 134/84,
- HR 78,
- EF 30% per echocardiogram.
Her labs are normal including a creatinine of 1.1. She denies chest pain or palpitations. Her EKG reveals normal sinus rhythm with no evidence of ischemia or recent acute coronary syndrome.
- How would you classify her heart failure?
Heart failure is a chronic condition in which the heart muscle is incapable of supplying sufficient blood to meet the needs of the body in terms of blood volume and oxygen. Ideally, the heart is unable to keep up with its workload…
- What changes (modifications, additions, deletions) to her medications do you recommend that will:
- Improve her symptoms?
- Impact long term outcomes?
- What monitoring parameters do you recommend?
- What non-pharmacologic recommendations do you have?
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