A 68-year-old woman, Mrs. M presents with a history of hypertension and paroxysmal atrial fibrillation. She complains of fatigue, dry cough, and shortness of breath while walking her dog or lying down flat. She is not experiencing chest pain or lightheadedness. She drinks alcohol rarely, has never smoked tobacco, and does not engage in recreational drug use.
She is taking the following medications:
- Diuretic
- Beta-blocker
- Angiotensin-converting enzyme inhibitor
- Anticoagulant
Her physical exam reveals:
- Body mass index 29 kg/m2
- Blood pressure 128/74 mm Hg
- Heart rate 88 beats/minute; regular rhythm; no murmur
- Bilateral rales
- Bilateral pedal edema
Her N-terminal pro B-type natriuretic peptide score is 990 pg/mL. All other laboratory tests are within normal limits. Electrocardiography shows normal sinus rhythm. On echocardiography, she has a left ventricular (LV) ejection fraction of 55%, LV wall thickness of 14 mm, and an average E/e’ ratio of 16.
Based on these results, you decide to initiate guideline-directed medical therapy for heart failure with preserved ejection fraction (HFpEF) and assess Mrs. M for symptomatic improvement.
Based on HFpEF guidelines, which class(es) of medication would help reduce Mrs. M’s risk of hospitalization for heart failure and cardiovascular death, and why?
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Ali Merchant1yrShe is in mild CHF so initial approach is to decongest. For the long term, treatment of her HFpEF with SGLT2i, MRA, and ARNI will help decrease risk of hospitalization Show More
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Omid Dardashti1yrFor this patient with HFPEF would add SGLT2I - Jardiance or Farxiga. As well her diuretic therapy should include MRA like spironolactone.
