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Finаl Exаm prep Quiz.pdf
A 68-yeаr-оld mаn presents tо the clinic fоr outpаtient follow-up with his cardiologist. He has a past medical history of benign prostatic hyperplasia (BPH) and a hospitalization for acute coronary syndrome (ACS) about 4 years ago, for which two drug-eluting stents were placed in the left circumflex artery. He is physically active and has not experienced anginal symptoms since his stents were placed. He does report mild dyspnea on exertion, but no dyspnea at rest. He reports sleeping better with 2 to 3 pillows at night. Medications include: aspirin, carvedilol (max dose), furosemide, amlodipine, tamsulosin, finasteride, simvastatin and sildenafil prn erectile dysfunction. Weight is 82 kg (180 pounds), BMI is 27.5, blood pressure is 156/98 mmHg, and heart rate is 68 beats per minute. His blood pressure has ranged from 148 to 156 mmHg systolic and from 92 to 98 mmHg diastolic during his previous two clinic visits. Upon physical exam, there is a mild S3 heart sound. There is mild elevation in his jugular venous pulse. There is trace lower-extremity edema. The remaining physical examination is unremarkable. Laboratory testing reveals normal BMP and renal function. An echo performed 9 months ago demonstrates left ventricular ejection fraction of 39%. Which of the following medications should be added to this patient's regimen?