A 68-year-old retired salesman has a history of an acute myocardial infarction complicated by congestive heart failure (CHF) 1 year ago. Although under appropriate medical management and in sinus rhythm, he presented with a 4-week history of progressive cardiac failure. He had 2 episodes of nocturnal cardiac dyspnea in the past week and was progressively limited in ordinary house and backyard activities. Medications for the management of his CHF were furosemide 20 mg daily, enalapril 20 mg daily, eplerenone 50 mg twice a day, carvedilol 25 mg twice a day, atorvastatin 10 mg daily, and a salt-poor, low-cholesterol-forming diet. On physical examination, he presented with 2+ ankle edema, blood pressure in the right arm was 140/75 mm Hg, respirations 20/min, height 1.75 m (5 ft 9 in), and weight 72 kg (160 lb). There was a positive hepatojugular reflux,...

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