ModerateCardiovascularHeart failure with reduced ejection fractionuk-plab-1
A 60 year old man presents with progressive exertional dyspnoea and ankle swelling. Examination reveals elevated jugular venous pressure, bilateral pitting oedema to the knees and bibasal crackles. Echocardiography shows left ventricular ejection fraction 30 percent with dilated left ventricle. He is already taking an angiotensin converting enzyme inhibitor and a beta blocker at target doses. According to NICE guidance, which additional disease modifying therapy should now be offered?