A 78-year-old woman with a history of hypertension treated with amlodipine was admitted 3 months ago for heart failure and atrial fibrillation. She came to your office for a cardiological check-up. The discharge report shows the result of the echocardiogram showing moderate left ventricular dysfunction and the discharge treatment: amlodipine was discontinued and furosemide and enalapril were started. The patient reports feeling better, without fatigue and with less leg edema, but she is still not completely well. Physical examination showed no signs of heart failure, but her blood pressure and heart rate were 150/90 mmHg and 120 bpm, respectively. The ECG shows atrial fibrillation at 110-120 bpm. Which treatment is most likely to improve symptoms and reduce mortality from cardiovascular events?
Typical very long and rambling question but not really too complicated... The patient is in heart failure with moderate ventricular dysfunction and also presents atrial fibrillation; she has criteria for anticoagulation, and between the two options that include acenocoumarol we are inclined to choose option 4, since it includes carvedilol, a drug that has been shown to increase survival in heart failure. Verapamil (and calcium antagonists in general) are contraindicated in systolic heart failure: they do not increase survival (they even increase morbidity and mortality) and specifically the non-dihydropyridines (verapamil and diltiazem) should not be associated with beta-blockers due to the increased risk of conduction system blockade.
Digoxin and acetylsalicylic acid.
Atenolol and acetylsalicylic acid.
Verapamil and acenocoumarol.
Carvedilol and acenocoumarol.
Carvedilol and clopidogrel.
Verapamil (and calcium antagonists in general) are contraindicated in systolic heart failure:
fibrillation; she has criteria for anticoagulation, and between the two options that include acenocoumarol we are inclined to choose option 4, since it includes carvedilol, a drug that has been shown to increase survival in heart failure.