11th May 2025

A 55-year-old woman presents to general practice with breathlessness on exertion and ankle swelling.

A 55-year-old woman presents to general practice with breathlessness on exertion and ankle swelling. She is comfortable at rest and able to do all her activities of daily living. She has a past medical history of angina, left sided heart failure, hypercholesterolaemia. She takes Sacubitril with valsartan 97/103 mg twice daily, bisoprolol 7.5mg once daily, 25mg spironolactone once daily, Empagliflozin 10 mg once daily, atorvastatin 80 mg once daily, aspirin 75mg once daily, GTN spray PRN. Recent echocardiogram shows left-sided systolic dysfunction with an ejection fraction of 30-35%, and some mild right-sided dysfunction, it also shows estimated mean pulmonary pressures of 30mmHg. You suspect a diagnosis of pulmonary hypertension secondary to left sided heart failure. On examination, you note oxygen saturations of 98% on room air, respiratory rate of 18, regular pulse at 65 beats per minute, blood pressure of 134/84. Recent blood tests show stable renal function and electrolytes. What of the following changes would be appropriate given her symptoms of increased breathlessness and ankle swelling? 

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