163) A 62 year old man with past medical history significant for Congestive Heart Failure presents with progressively increasing shortness of breath over the past 2 months. He denies any chest pain on exertion or at rest. He was recently started on furosemide for management of peripheral edema and is compliant with low salt diet. An Echocardiogram obtained 3 months ago revealed an Ejection Fraction of 32% (Normal = above 55%) at which time he was started on Enalapril. On physical examination, there is trace ankle edema. There are no lung crackles on auscultation. Rest of the examination is normal. An EKG reveal changes of left ventricular hypertrophy with normal QRS duration. The most important intervention at this time that would most improve his survival is
A) Start Losartan
B) Start Carvedilol
C) Start Isosorbide and Hydralazine
D) Add Digoxin
E) Biventricular Pacing
e
when CHF with EF 0.12 = Indication to bivetricular pacing
C) Start Isosorbide and Hydralazine
b
b
beta blockers have shown to improve survival in stable CHF – Answer B