Problem
A 50 year of 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 5'2", 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.
A. How would you classify her heart failure?
B. What changes (modifications, additions, deletions) to her medications do you recommend that will:
a. Improve her symptoms?
b. Impact long term outcomes?
C. What monitoring parameters do you recommend?
D. What non-pharmacologic recommendations do you have?
A 79-year-old African American woman with a history of hypertension, transient ischemic attack (TIA) and gout. Her medications include febuxostat 80 mg/day, felodipine 10 mg/day, benazepril 40 mg/day, and enteric coated aspirin 81 mg/day. Her vital signs include BP 145/85 mmHg and HR 82 beats/minute.
What is the best approach to improve her BP control, if anything? Please provide your answer supporting it with evidence based medicine.
Is there anything else that should be addressed in the patient?