7th March 2024

A 43-year-old male with a background of T2DM, known dilated cardiomyopathy and an LVEF of 30-35% on their most recent echo attends their regular cardiology appointment.

A 43-year-old male with a background of T2DM, known dilated cardiomyopathy and an LVEF of 30-35% on their most recent echo attends their regular cardiology appointment. They say that they are symptomatically stable currently and their observations are as follows:

HR 85, BP 95/60 mmHg, Temp 36.3, SaO2 98% on room air, RR 14.

Their ECG shows an HR of 75bpm, sinus rhythm, QRS duration of 119ms, and non-specific t-wave abnormalities. Recent bloods show normal FBC, stable electrolytes and creatinine within normal ranges. On examination, they are euvolemic. They are currently on the following medications: Bisoprolol 10 mg OD, Sacubitril-Valsartan 49/51mg BD, Dapagliflozin 10 mg OD, Spironolactone 50 mg OD, Furosemide 40 mg OD. Which of the following would be a suitable next step addition to their therapies? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.