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: height sr. 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.
1. How would you classify her heart failure?
2. What changes (modifications, additions. deletions) to her medications do you recommend that will: o Improve her symptoms? o Impact long term outcomes?
3. What monitoring parameters do you recommend?
4. What non-pharmacologic recommendations do you have?
Sample Solution
- Based on the information provided, the patient’s heart failure can be classified as
Sample Solution
- Based on the information provided, the patient’s heart failure can be classified as
- Based on the information provided, the patient’s heart failure can be classified as **stage C**.
- The following changes to her medications are recommended:
– **Addition of ACE inhibitors or ARBs** to her current medications as they have been shown to improve symptoms and reduce mortality in patients with heart failure with reduced ejection fraction (HFrEF).
– **Discontinuation of HCTZ** as it can worsen heart failure³.
– **Consideration of beta-blockers** as they have been shown to improve symptoms and reduce mortality in patients with HFrEF.
- The following monitoring parameters are recommended:
– **Weight monitoring** to detect fluid retention.
– **Blood pressure monitoring** to ensure that blood pressure is controlled.
– **Echocardiography** to assess left ventricular function.
- The following non-pharmacologic recommendations are suggested:
– **Dietary sodium restriction** to reduce fluid retention.
– **Regular exercise** as it has been shown to improve symptoms and quality of life in patients with heart failure.
Please note that this is not a substitute for medical advice. Please consult your doctor for further evaluation and management.
