A 72-Year-Old Man Is Evaluated for Progressive Exertional Dyspnea Over

A 72-year-old man is evaluated for progressive exertional dyspnea over the last 2-3 years.  His current exercise tolerance is walking one block on flat ground, and he gets very short of breath when climbing stairs.  He takes amlodipine for hypertension.
Blood pressure is 154/90 mm Hg, pulse is 88/min, and oxygen saturation at rest is 96%.  BMI is 32 kg/m².  Breath sounds are decreased at the lung bases with scattered crackles.  The remainder of the examination is within normal limits.
Transthoracic echocardiogram shows moderate left atrial enlargement, mild left ventricular hypertrophy, normal valves, and left ventricular ejection fraction of 60%.  Coronary angiography shows no obstructive coronary disease.  Right heart catheterization shows pulmonary capillary wedge pressure of 28 mm Hg and pulmonary artery pressure of 70/30 mm Hg (mean pressure 42 mm Hg) .
Which of the following is the best initial management for this patient?

A) Bosentan
B) Carvedilol
C) Furosemide
D) Nocturnal oxygen
E) Rivaroxaban

Correct Answer:

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