Dennis is an 80-year-old Black male with

Dennis is an 80-year-old Black male with a history of smoking (current), ETOH (claims he no longer drinks), epileptic seizures from a right fronto-temporal region (for approximately 4 years) and a history of heart failure with preserved ejection fraction. His ejection fraction (EF) by echocardiography was 50% when diagnosed years ago presumably from hypertension. His more recent echocardiogram revealed left ventricular hypertrophy and abnormal relaxation [stage 1], left ventricular end-systolic and end-diastolic diameters of 2.6 cm and 3.6 cm, respectively (normal), EF 50%, 3+ tricuspid regurgitation (TR), and right ventricular systolic pressure (RVSP) 38 mm Hg (mild pulmonary hypertension). He was last seen 6 weeks ago and has not been hospitalized or treated in an emergency department setting since his last visit. He states that his breathing ability and energy level are similar to his last visit. He can climb one flight (14 steps) before becoming dyspneic. He has 2 pillow orthopnea but no paroxysmal nocturnal dyspnea. Dennis has fatigue with activities of daily living. He denies chest pain, palpitations, lightheadedness, dizziness, nausea, edema, or difficulties with eating. He follows a low sodium diet. Dennis has no known allergies. He has a history of A-fib but is now in SR. Physical exam: alert, cooperative, no jugular venous distension, no hepatojugular reflux, no peripheral edema. Lungs clear, abdomen is soft and nontender. Heart rate and rhythm are regular, has a 2/6 systolic murmur at the left lower sternal border. BP, 152/64 mm Hg; pulse, 64 bpm; weight, 132 lbs (60 kg); NYHA FC II-III. Medications: metoprolol succinate (Toprol XL) 150 mg/daily paroxetine (Paxil) 10 mg/daily levetiracetam (Keppra) 500 mg/twice daily amlodipine (Norvasc) 10 mg/daily ramipril (Altace) 10 mg/ twice daily aspirin 325 mg/daily Magnesium oxide (Mag-Ox) 400 mg/twice daily gabapentin (Neurotin) 300 mg/twice daily Serum laboratory history: Sodium, 136 mmol/L Potassium, 4.7 mmol/L BUN, 22 mg/dL creatinine, 1.3 mg/dL total cholesterol 174 mg/dL; HDL 62 mg/dL; LDL 93 mg/dL; triglycerides 96 mg/dL What is your plan for Dennis? Increase the dose of metoprolol succinate to 200 mg daily Add atorvastatin 20 mg QD Stop metoprolol succinate Increase dose of amlodipine to 15 mg daily Start HCTZ 12.5 mg daily

******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."