10th May 2025

Mr. Patel, a 65-year-old accountant, presents with worsening exercise tolerance, breathlessness and ankle swelling.

Mr. Patel, a 65-year-old accountant, presents with worsening exercise tolerance, breathlessness and ankle swelling. He has a history of myocarditis diagnosed eight months ago, requiring a 6-day inpatient admission. Physical examination reveals an irregular rhythm with an S3 gallop and mild bilateral ankle oedema. Echocardiogram shows reduced left ventricular function with an ejection fraction of 35% and he is therefore diagnosed with heart failure.

Which of the following are examples of the ‘4 pillars’ of heart failure medications that Mr Patel should be started on?

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