A patient comes to the clinic with a recent onset of nocturnal and exertional dyspnea. The primary care nurse practitioner (NP) auscultates S3 heart sounds but does not palpate hepatomegaly. The patient has mild peripheral edema of the ankles
The NP should consult a cardiologist to discuss prescribing a(n): a. B-blocker.
b. loop diuretic.
c. angiotensin-converting enzyme (ACE) inhibitor.
d. angiotensin receptor blocker (ARB).
B
This patient shows signs of systolic heart failure. Treatment for heart failure should begin with a loop diuretic, with an ACE inhibitor added after the diuretic has been taken. B-Blockers are used in patients with minimal fluid retention and would be added later. ARBs are used if ACE inhibitors are not tolerated or are ineffective.
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