Patient: A 66-year-old woman History: Known coronary artery disease; 2 previous myocardial infarctions (MIs); the first one was seven years ago, and the second one was 11 months ago. The ejection fraction after the second MI was documented to be 28%.
She currently has class II NYHA heart failure. Ongoing medications · Lisinopril - 40 mg/d · Carvedilol - 12.5 mg twice daily · Aldosterone - 25 mg/d · Aspirin- 81 mg/d · Pravastatin - 20 mg/d Examination ·Blood pressure - 116/72 mm Hg ·Heart rate - 60 beats/min; regular ·Jugular venous pressure - Flat ·No peripheral edema ·Lungs clear with good breath sounds at both bases Laboratory tests · Sodium - 138 mEq/L · Potassium - 4.4 mmol/L · Creatinine - 1.2 mg/dL Echocardiography · Ejection fraction - 32% with mild mitral regurgitation ·A markedly enlarged left ventricle with anterior wall hypokinesis Electrocardiography · Heart rate - 60…
