Skill Checkup: A 62-Year-Old Black Male With History of Hypertension Experiences Mild Cognitive Impairment and Breathlessness

Jeffrey J. Hsu, MD


March 13, 2023

Discontinuation of diltiazem and initiation of treatment with GDMT that is uptitrated to the maximal dosage is the appropriate treatment strategy for this patient. According to the 2022 AHA/American College of Cardiology/Heart Failure Society of America guidelines for the management of HF, GDMT consists of four core medication classes: renin-angiotensin system (RAS) inhibitors, sodium-glucose cotransporter-2 (SGLT2) inhibitors, beta blockers, and mineralocorticoid receptor antagonists (MRAs). Angiotensin receptor-neprilysin inhibitor/angiotensin-converting enzyme inhibitor/angiotensin receptor blockers inhibit the RAS and are recommended for all patients with new-onset stage C HFrEF to reduce morbidity and mortality.

Diltiazem is a calcium channel blocker that is used to treat hypertension, but it is not the most appropriate treatment for HFrEF. Nondihydropiridine calcium channel blockers may be harmful to patients with HFrEF owing to their negative ionotropic effects.

Warfarin is a vitamin K antagonist that acts as an anticoagulant used to prevent blood clots.

Oxygen therapy can be used to relieve breathlessness in some patients with HF, but it is not a primary treatment for the causes of HF and should be used in conjunction with other treatments.


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