Sample Consults

SPECIALTY
Cardiology

CHIEF COMPLAINT
Congestive Heart Failure

COMMENTS TO SPECIALIST
This is a 67-year-old female with morbid obesity, seizure, chronic systolic heart failure, and chronic stage II kidney disease. Recently, in the hospital with urosepsis, pneumonia, and acute, chronic heart failure with brain natriuretic peptide (pro-BNP) of 26,800. Elevated troponins due to type II myocardial infarction.

She was ultimately started on furosemide 40 mg a day, carvedilol 6.25 mg twice a day, and spironolactone 25 mg a day. During her hospital stay, she had episodes where she was on pressure support as well as Diamox for metabolic acidosis. While there, she had an echocardiogram that showed a left ventricular ejection fraction of 30% to 35%. The patient remains a full code.

Cardiology considered Entresto but wanted to wait until her blood pressure and sepsis improved. Her blood pressure is now 120 systolic.

MAIN QUESTION
Is it safe to start Entresto?

For reference only. This eConsult is based on an actual request for specialist consultation. The primary care provider, specialist, and patient are de-identified to protect private health information (PHI).