Reference no: EM133759521

Question

J.S. is subsequently admitted to the hospital's chest pain observation unit. A nuclear imaging stress test is normal. Transthoracic echocardiogram is notable for mild left ventricular hypertrophy, mild mitral regurgitation, mild tricuspid regurgitation and early diastolic dysfunction. J.S. is discharged home with hydrochlorothiazide 25 mg daily, Lisinopril 10 mg daily, and atorvastatin 40 mg daily. J.S. is lost to follow-up and presents to primary-care clinic 3 years later at age 58 years with a 2-month history of weight gain, shortness of breath, orthopnea, and lower-extremity edema. Her review of systems is otherwise negative. She has self-discontinued all of her medications for an unspecified period of time. She has maintained her nonsmoking status. Her vital signs are as follows: pulse, 98 beats/min blood pressure, 180/100 mmHg oxygen saturation, 93% on room air. Her clinical examination is significant for elevated jugular venous distention, crackles at both lung bases, and S3 gallop on heart auscultation. Physical exam is consistent with the diagnosis of coronary heart failure (CHF). Construct a plan that includes at least four interventions to prevent the progression of cardiovascular disease in this patient.