solved

A 50yo African American woman presents to clinic feeling tired for the last 3 months. She also has trouble breathing when walking 2-3 blocks. She sleeps on 2 pillows at night to help with her breathing. PMH: HTN, arthritis. Physical exam: edema present in both feet.
Medications: HCTZ 12.5mg daily
verapamil SA 120 mg daily
ibuprofen 200 mg BID for arthritis in knee.
Vitals: height 5’2″, 63kg, BP 134/84, HR 78, EF 30% per echocardiogram. Her labs are normal including a creatinine of 1.1 and she denies chest pain or palpitations. Her EKG reveals normal sinus rhythm with no evidence of ischemia or recent acute coronary syndrome.
How would you classify her heart failure?
What changes (modifications, additions, deletions) to her medications do you recommend that will:
Improve her symptoms?
Impact long term outcomes?
What monitoring parameters do you recommend?
What non-pharmacologic recommendations do you have?

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