A 67-year-old man had tri...

A 67-year-old man had triple bypass surgery 17 years ago for hypertension, hyperlipidemia, and coronary artery disease. His current home medications are amlodipine 10 mg once daily, atorvastatin 80 mg once daily, and aspirin 81 mg once daily. Nevertheless, he comes to the clinic complaining of shortness of breath, which he gets while doing ordinary duties like mopping the floor. Due to orthopnea, he says he sleeps on a recliner at night. Systolic dysfunction, mild mitral regurgitation, a dilated left atrium, and a 30% ejection fraction (EF) are all seen on echocardiography. Laboratory results show a pro-B-type natriuretic peptide level of 1302 pg/mL, a troponin level of <0.34, and an unremarkable basic metabolic panel (BMP). Measurement of vital signs shows blood pressure (BP) of 156/92 mm Hg, a heart rate of 80 beats/min, a Spo2 of 94%, a temperature of 36.5 °C, a pain level of 2 on a scale of 10, and a weight of 185 lb (84.1 kg).