Heart Failure

A 58-year-old man from Delhi presents with progressive dyspnea on exertion for 3 months, orthopnea, and bilateral ankle edema. He has a history of hypertension (BP 160/100 mmHg today) and type 2 diabetes. On examination, JVP is elevated at 8 cm, S3 gallop is audible, and fine crackles are heard at both lung bases. Chest X-ray shows cardiomegaly and bilateral pulmonary edema. Echocardiography reveals LVEF 35%, global hypokinesis, and LV end-diastolic dimension 62 mm. Which of the following is the most appropriate initial pharmacological intervention?

A 72-year-old woman from Mumbai with a 10-year history of hypertension and diabetes presents with progressive dyspnea, fatigue, and ankle swelling for 6 weeks. On examination: BP 145/92 mmHg, HR 88/min regular, JVP 6 cm, no S3 gallop, lungs clear to auscultation bilaterally. Echocardiography shows LVEF 52%, LV wall thickness 14 mm, LA enlargement, and restrictive mitral inflow pattern (E/A ratio 2.2, E/e' ratio 14). Which of the following is the most likely diagnosis?

A 58-year-old man with hypertension and type 2 diabetes mellitus presents with dyspnea on exertion and orthopnea. Echocardiography reveals left ventricular ejection fraction (LVEF) of 35%. He is euvolemic on examination. What is the drug of choice for initiating therapy in this patient with heart failure with reduced ejection fraction (HFrEF)?

A 62-year-old woman with HFrEF (LVEF 28%) and hypertension is already on enalapril 10 mg daily and metoprolol 95 mg daily. She remains symptomatic with NYHA Class III dyspnea. Which agent should be added next to reduce mortality and improve symptoms?

A 58-year-old man with a 3-year history of hypertension presents with progressive dyspnea on exertion, orthopnea, and peripheral edema for 2 weeks. Physical examination reveals elevated JVP, bibasal crackles, and a third heart sound. Chest X-ray shows pulmonary edema and cardiomegaly. Which investigation is most appropriate to determine the etiology and guide further management?