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Bob is a 72 year old Caucasian male with a known history of CAD with 3V CABG in 2013, essential hypertension, mixed hyperlipidemia, and class 2 obesity. He is new to the area and does not have a local cardiologist. He presents for a new patient visit and is with complaints of mild DOE and cough. Vitals show uncontrolled BP of 158/92 and he states he has an increased weight of 5 pounds from last doctors visit. He has new 1+ pitting edema of ankles and fine rales in left base. EKG reveals no acute abnormalities, CXR shows a questionable left pleural effusion. BMP showed a creatinine of 1.2 and normal potassium. Current medications include ASA 81mg daily, Coreg 25mg bid, and atorvastatin 80mg daily, You added Lasix 20mg bid and ordered repeat labs and an echocardiogram with short follow up in a few days. He returns with a 3 pound weight loss, improved lung sounds, and 50% improvement in symptoms. BMP normal. Echocardiogram revealed an EF of 40% and cardiology can’t see him for another 2 weeks. How do you proceed? What is your next medication choice and at what dosage? Do you order any additional labs? What education
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