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Cardiology - Heart Failure
A 56-year-old man with recently diagnosed non-ischaemic dilated cardiomyopathy presented with persistent exertional dyspnoea, fatigue, and reduced exercise tolerance despite treatment with guideline-directed medical therapy. He was in New York Heart Association (NYHA) functional class III. Echocardiography showed a dilated left ventricle with a left ventricular ejection fraction (LVEF) of 28%. There was no significant valvular disease or documented coronary artery disease.
He was receiving sacubitril/valsartan, carvedilol, dapagliflozin, and furosemide at tolerated doses. His blood pressure was 108/68 mmHg, heart rate 72 beats/min, and there was mild bilateral ankle oedema. Laboratory evaluation showed a serum potassium of 4.3 mmol/L and estimated glomerular filtration rate (eGFR) of 62 mL/min/1.73 m².
Despite treatment, symptoms persisted, and systolic function remained markedly impaired. Given his symptomatic heart failure with reduced ejection fraction (HFrEF), preserved renal function, and serum potassium within an acceptable range, an additional disease-modifying therapy was considered.
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