6th May 2025

A 62-year-old lady is reviewed in the heart failure clinic.

A 62-year-old lady is reviewed in the heart failure clinic. Despite being on maximum doses of furosemide, bisoprolol, enalapril and spironolactone, she remains symptomatic. Her most recent ECHO reveals an ejection fraction of 26%. 

Her recent results are as follows:

ECG: Sinus rhythm, HR 58 bpm 

CXR: Enlarged heart, clear lung fields

She was started on isosorbide mononitrate with hydralazine but this was stopped due to side effects. Which of the following can be added onto her current heart failure medication regime?

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