Your patient is a 70-year-old woman with a 5-year history of ischemic cardiomyopathy. She has advanced HF symptoms and is currently New York Heart Association ( NYHA) class III. She has chronic volume overload on examination, but no acute worsening. Her medical regimen has been stable for the past 3 months and includes enalapril 20 mg 2 times/day, Bisoprolol 2.5 mg once daily, digoxin 0.125 mg orally once daily, furosemide 80 mg 2 times/day, ASA 325 mg once daily, glyburide 5 mg once daily, potassium chloride (KCl) 20 mEq orally 2 times/day, and isosorbide dinitrate 20 mg orally 3 times/day. Her BP is 120/80 mm Hg and HR is 80 beats/minute. Her Na is 136 mEq/L, K 4.4 mEq/L, BUN 40 mg/dL, and SCr 1.8 mg/dL. Which one of the following interventions is indicated at this time?

D.F. is an 84-year-old woman with a medical history significant for type 2 DM (diet controlled), osteoporosis, hypercholesterolemia, and HTN who presents to the clinic with a 1-year history of dyspnea on exertion, which has worsened over the past month. Her medications are lisinopril 20 mg daily, alendronate 70 mg once weekly, calcium/vitamin D 500 ng/125 international units three times daily, simvastatin 20 mg daily, and aspirin 81 mg daily. Vital signs include blood pressure 120/80 mm Hg and heart rate 80 beats/minute. Physical examination reveals lungs: + rales/rhonchi; cardiac: JVP elevated to 7 cm with a large V wave, S3 present; and extremities: 2+ edema to knee bilaterally. Laboratory values are as follows: SCr 1.2 mg/dL, K 4.7 mEq/L, and BNP 856 pg/mL. An ECHO reveals an LVEF of 66%, mild tricuspid regurgitation, mild mitral regurgitation, and global hypokinesis. An ECG reveals LV hypertrophy. Which is the most appropriate therapeutic recommendation for D.F.’s HF at this time?

A patient with NYHA functional class IV HF (LVEF less than 40%) currently receives the following medications: lisinopril, bisoprolol, furosemide, digoxin, amlodipine, spironolactone, pregabalin, sertraline, glipizide, and colchicine (as needed). Which medication would most likely exacerbate this patient’s HF?

N.T. is a 68-year-old woman (height 63 inches, weight 58 kg) who presents to the hospital with NVAF. After her heart rate is controlled with metoprolol, she is asymptomatic. She also has hypertension, type 2 diabetes, osteoarthritis, and depression. Her current medications include metoprolol 100 mg twice daily, lisinopril 10 mg daily, metformin 1000 mg twice daily, acetaminophen 1000 mg three times daily, and citalopram 20 mg daily. Her heart rate is currently 82 beats/minute and blood pressure is 130/88 mm Hg. Her serum creatinine (SCr) is 0.8 mg/dL and creatinine clearance (CrCl) is 60 mL/minute/1.73 m2; she has normal hepatic function Which is the most appropriate stroke prevention strategy for this patient?

H.D. is a 67-year-old man with a history of hypertension, moderate mitral valve insufficiency, and AF for 4 years. His medications include ramipril 5 mg two times/day, Propafenone 150 mg three times/day, digoxin 0.125 mg/day, and warfarin 5 mg/day. He visits his primary care physician today after being discharged from the emergency department with increased fatigue on exertion and palpitations with lower extremity edema. His vital signs today include BP 115/70 mm Hg and HR 88 beats/minute; all laboratory results are within normal limits; however, his lower extremity edema has worsened. His INR is 2.8. His ECG shows AF. An echocardiogram shows an LVEF of 35%–40%. A rhythm control approach to H.D.’s therapy is chosen. Which is the best approach for managing his AF?

According to the ACC/AHA blood cholesterol guidelines, which is best described as a high-intensity statin dose?

A 54-year-old man presents to the clinic for a follow-up of his hypertensive drug regimen. His medical history is significant for HTN and coronary artery disease (CAD). To control his blood pressure, he takes amlodipine 10 mg/day, lisinopril 40 mg/day, and chlorthalidone 25 mg/day. Today in the clinic, his vital signs include blood pressure 154/96 mm Hg and heart rate 70 beats/minute, and his laboratory results are all within normal values. Which would best manage this patient’s HTN?

M.M. is a 63-year-old white woman who just finished 6 months of diet and exercise for dyslipidemia. She has a history of gout, chronic nonischemic HF (LVEF 26%), diet-controlled diabetes, and asthma, as well as a 15 pack-year history of tobacco (quit 3 years ago); she drinks 3 beers a day. Because she was adopted, no family history records are available. Her medications are albuterol metered dose inhaler, lisinopril, furosemide, and Tums 2 tablets/day. Her vital signs include BP 124/80 mm Hg and HR 75 beats/minute. Her laboratory results are as follows: HDL-C 64 mg/dL, LDL-C 101 mg/dL, TG 98 mg/dL, and TC 185 mg/dL. Her pooled cohort equation estimates a 10-year ASCVD risk of 30 %. Which is the most appropriate next step for M.M.?

J.T. is a 58-year-old man who presents to his primary

care provider for the first time in 10 years.

He has smoked 2 packs/day for the past 30 years

and takes no medication. A fasting lipid panel

shows total cholesterol (TC) 222 mg/dL, lowdensity

lipoprotein cholesterol (LDL-C) 105 mg/dL,

triglycerides (TG) 330 mg/dL, and high-density

lipoprotein cholesterol (HDL-C) 51 mg/dL. His

vital signs include BP 140/75 mm Hg and HR 80

beats/minute. His pooled cohort equation reveals

a 10-year atherosclerotic cardiovascular disease

(ASCVD) risk of 14.6%. Which would be the best

pharmacologic therapy to initiate in J.T.?