13th March 2024

A 46-year-old female is seen in the acute cardiology clinic for worsening ankle swelling over the last few weeks.

A 46-year-old female is seen in the acute cardiology clinic for worsening ankle swelling over the last few weeks. She reports over the last month, she has felt feverish with myalgia and a runny nose. Chest auscultation is clear, but you note bilateral pitting oedema up to the knees. 

Initial troponin T is raised at 84ng/L. The second and third troponins are 88ng/L and 90ng/L respectively. An urgent echocardiogram is performed, which reveals hypokinetic inferior wall and apical segments. Ejection fraction is estimated at 43%. 

Her latest observations are BP 121/84mmHg, HR 86 bpm, SO2 94% on room air, RR 17 and temperature of 37.3°C. Your consultant is concerned about the possibility of myocarditis and has asked you to initiate optimal medical therapy whilst the patient awaits further investigations. Which of the following combinations of medications is recommended in this patient?

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