Systolic Heart Failure

Abstract

A 74-year-old man with a history of hypertension and myocardial infarction that had occurred in the remote past presents with breathlessness on exertion. On examination, his pulse is 76 beats per minute and his blood pressure is 121/74 mm Hg. There is jugular venous distention and edema in the lower limbs; the lungs are clear. An echocardiogram shows left ventricular dilatation and an ejection fraction of 33%. How should his case be managed?