A 66-year-old man with ischaemic cardiomyopathy attends for review. Echocardiography shows a left ventricular ejection fraction of 30%, and he remains breathless climbing a flight of stairs despite maximally tolerated perindopril, bisoprolol at target dose and spironolactone. He does not have diabetes (HbA1c 36 mmol/mol) and his eGFR is 58 mL/min/1.73 m². His blood pressure is 112/70 mmHg, heart rate 62/min and regular; the lungs are clear and there is no peripheral oedema. Which one of the following additional medications is most likely to reduce his risk of death and hospitalisation for heart failure?
More from AMC
See allA 17-year-old girl presents six hours after a deliberate ingestion of tablets taken from the family bathroom cabinet. She complains of nausea, repeated vomiting…
A 28-year-old woman is brought in by ambulance 90 minutes after being found drowsy next to an empty box of amitriptyline. Her Glasgow Coma Scale score is 12, he…
A 21-year-old man collapses at the 14 km mark of a city fun run on a 34°C day. In the trackside medical tent he is confused and agitated with a Glasgow Coma Sca…
A 26-year-old backpacker is snorkelling off Port Douglas in far north Queensland in December when she feels a mild sting on her forearm, leaving only faint redn…
A 34-year-old man in suburban Sydney felt a sharp pinprick on the back of his hand while moving pot plants stacked against the house. Over the next two hours he…