Yоu hаve been the PCP fоr а 72-yeаr-оld female for the past 3 years. Her 2 daughters brought her to clinic today. She currently lives in her own home alone and her daughters live nearby. Her daughters are concerned about her because she has been more forgetful and recently had trouble driving home from church. She got lost and had to stop and ask how to get to her address. They have noticed these changes over the past year or so, but more often lately. She denies headaches, chest pain, and palpitations. lightheadedness, SOB or loss of consciousness. She states that she has been eating well, sleeping well, she enjoys a glass of wine with friends every other week or so. Her husband of 46 years died 4 years ago. She has stayed active in her community and in her church. She has generally been in good health and has regular health care, follow up. She misses her husband but has generally been in good spirits. PMH: Stable hypothyroid - diagnosed 8 years ago Complete PE: results within normal limits Medications: Levothyroxine 50 mcg daily, no other medications, herbs or supplements Labs (2 days ago): CBC, CMP, TSH, vitamin B12, folate: normal. Lipids, mildly elevated (you and MA have chosen not to treat with medication) EKG: NSR, no ectopy You are concerned about the potential for early dementia. You review the chart, talk to the patient and family, and consider the following in your diagnosis:
Yоu аre seeing а 68-yeаr-оld male with hypertensiоn and non-ischemic cardiomyopathy in clinic today. He has the diagnosis of heart failure with reduced ejection fraction (HFrEF). An echocardiogram one month ago showed left-ventricular hypertrophy and a left-ventricular ejection fraction (LVEF) of 36%. He takes sacubitril/valsartan 97/103 mg (Entresto) BID and carvedilol (COREG) 12. 5 mg PO BID. His pulse is 68 beats/minute, blood pressure is 134/88 mmHg, and oxygen saturation is 95% on two liters of oxygen by nasal cannula. His weight is up 8 pounds from his last clinic appointment. His physical exam is notable for jugular venous pulse and pressure (JVP) of 12, bilateral leg edema, and crackles at his lung bases. What will be the next step in management of this man?