A 62-year-old man with heart failure (EF 30%) started on carvedilol 2 weeks ago presents with fatigue and orthostatic dizziness. Vital signs: BP 98/62 mmHg (baseline 125/80), HR 52 bpm, RR 16, temp 98.6°F, SpO2 98% on room air. BNP is 250 pg/mL. He denies dyspnea or peripheral edema. Recent echocardiography confirms EF 30% with no acute changes. Which intervention is most appropriate?

  1. A)Discontinue carvedilol immediately due to intolerance
  2. B)Increase sodium intake to maintain blood pressure
  3. C)Add a dihydropyridine calcium channel blocker to offset hypotension
  4. D)Reduce the dose and titrate slowly; this is expected with initiationGABARITO
  5. E)Switch to a selective beta-1 blocker for better tolerability

Explicação

Initial hypotension and fatigue with beta-blockers in heart failure are expected and typically resolve with slow titration. Dose reduction and gradual uptitration according to tolerance is the standard approach, not discontinuation. Ver explicação completa e trilha adaptativa →

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