Question: D.H., a 63-year-old man, comes to the ED with difficulty breathing that has been getting progressively worse. He reports a 6-kg weight gain this past
D.H., a 63-year-old man, comes to the ED with difficulty breathing that has been getting progressively worse. He reports a 6-kg weight gain this past week. D.H.'s medical history includes hypertension, type 2 diabetes (T2D), obesity, and gastroesophageal reflux disease. He recently moved to the area and does not have a primary care provider. D.H.'s last visit to a primary care provider was over 1 year ago, and he is not currently taking any medications. On clinical examination, he is noted to have jugular vein distension, the presence of S3 gallop, and peripheral edema. His laboratory results include sodium (Na) 136 mEq/L, potassium (K) 4.3 mEq/L, SCr 1.1 mg/ dL, and N-terminal pro-brain natriuretic peptide (NT-proBNP) 7608 pg/mL (reference range, less than 900 pg/mL). Cardiology is consulted, and an ECHO reveals an LVEF of 55% to 60% with a mildly thick LV wall. D.H.'s vital signs include blood pressure 152/75 mm Hg, pulse rate 72 beats/min, respiratory rate 26 breaths/min, and oxygen saturation 98% on room air. 2. Which one of the following is best to recommend for D.H.'s volume overload? A. Spironolactone B. Sacubitril/valsartan C. Carvedilol D. Furosemide
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