A 70 year old man with a history of myocardial infarction presents to the ER with shortness of breath and chest pain. Over the past 2 weeks he has developed increasing dyspnea with exertion and swelling in the limbs. Over the past 3 days he has found the need to elevate his head while sleeping to reduce the incidence of coughing and shortness of breath. At the moment he uses 4 pillows. In the ER while sitting upright he seems to be in respiratory distress and is tachycardic with a blood pressure of 195/112. JVD is predominant. Upon auscultation of the lungs rales are heard bilaterally and he has pitting edema of both lower legs up to his knees. Chest x-ray confirms pulmonary edema and he is immediately place on oxygen. He is currently on hydrochlorothiazide, metoprolol and enalapril.What would be the anticipated diagnosis for a patient with the clinical presentation in the case above? Correlate the symptoms noted with the pathophysiology of the condition you identified. What pharmacologic agent would be anticipated as the first management step for this patient and why? Explore and describe any potential interactions of the anticipated pharmacologic agent and the patient’s existing pharmacologic management.
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