**(5 ) A 72-year-old man with a history of chronic heart failure - TopicsExpress

**(5 ) A 72-year-old man with a history of chronic heart failure secondary to ischaemic cardiomyopathy is reviewed. Despite his current treatment with frusemide, ramipril, carvedilol, aspirin and simvastatin he remains short of breath on minimal exertion such as walking 30 metres. On examination his chest is clear and there is minimal peripheral oedema. What is the most appropriate next management step? A. Stop aspirin B. Refer for cardiac resynchronisation therapy C. Switch carvedilol to bisoprolol D. Add angiotensin-2 receptor blocker E. Add spironolactone

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