Tuesday, October 25, 2011

What Will be the next step in Management of this Patient?


A 69 year old female with significant history of DM Type 2, Diabetic neuropathy, Hypertension and Congestive heart failure is seen at your OPD for regular check-up. Her last echocardiography was done 5 months ago and it revealed an ejection fraction of 50%. Her medications include gabapantin, Sitagliptan, Hydrochlorthiazide and glyburide. Her vitals are BP of 1130/85, HR 88, RR 19 and Temperature 98.4F. Currently She has no fresh complaints . Her physical examination is also normal. There is no jugulovenos distension and her chest is B/L clear on auscultation. Which of the following is the next step in management of the patient?

A. Continue with current therapy and see her in 2 months. 
B. Add Lisinopril
C. Add Carvedilol
D. Add both carvedilol and lisinopril 
E. Stop Hydrochlorthiazide and prescribe Lisinopril. 


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