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 pt. with history of congestive heart failure.  

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pt. with history of congestive heart failure...visits clinic for routine exam and has no complaints....her ejection fraction been stable at 25% for many years.Medications are: high dose of enalapril, furosemide, digoxin,daily aspirin. Physical exam is unremarkable except for 1+ edema (ankles). The most appropriate next step in management?


Add spironolactone (diuretic effect + inhibition of local AgII receptors in miocard). Might consider new diuretics.


Is it necessary to add beta blocker? If CHF is stable, the standard of care is to add beta blocker :?: please, clarify. Thanks!

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