24th April 2024

A 76-year-old woman attends heart failure clinic complaining of persistent breathlessness at rest and fatigue despite medication compliance.

A 76-year-old woman attends heart failure clinic complaining of persistent breathlessness at rest and fatigue despite medication compliance. She has a past medical history of type 2 diabetes, hypertension, and heart failure with reduced ejection fraction. Her current medications include: ramipril 10mg OD, metformin 500mg BD, carvedilol 25 mg BD, dapagliflozin 10 mg OD, spironolactone 50 mg OD and furosemide 40 mg OD. You review her most recent echocardiogram and note an ejection fraction of 33%. Her observations are: pulse 65 bpm regular, blood pressure 130/80, respiratory rate 16, saturation 97% on room air and temperature 37 degrees Celsius. Which of the following medications is indicated to manage her heart failure symptoms? 

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