Chronic Systolic Heart Failure in Medicine / Internal Medicine — 60yo Woman | Cardiology | SMLE Q#10999
SMLE Question #10999
Medicine / Internal Medicine
Cardiology
Objective: OBJ-163
Last updated: February 2026
A 60-year-old woman with chronic systolic heart failure reports 3 months of worsening dyspnea on ordinary activity, new orthopnea (3 pillows), and paroxysmal nocturnal dyspnea. She is taking fosinopril, carvedilol, and furosemide regularly. Examination shows a displaced diffuse apical impulse, soft S3, bibasal crackles, and mild ankle edema. Echocardiography shows a dilated left ventricle with LVEF 30% and global hypokinesis, with no significant valvular disease. Which additional drug should be added to improve her symptoms and survival?
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