MRCP2-0295
A 75-year-old man visits his doctor to discuss his medication. He reports feeling more fatigued and getting easily tired than before, and he experiences shortness of breath after climbing stairs, which was not a problem until about 4 months ago. He also thinks he has gained a few kilograms of weight, despite having a poor appetite lately. He denies any history of chest pain.
During the physical examination, the patient’s heart rate is 68 beats per minute with a regular rhythm, and his blood pressure is 110/90 mmHg. His extremities are cool, and his carotid pulse is difficult to feel. Upon auscultation of his precordium, the doctor notes an inaudible 2nd heart sound and a crescendo-decrescendo murmur that is loudest at the right upper sternal border and radiates to his neck. The doctor also hears audible crepitations bi-basally, and the patient has 1+ peripheral edema.
Which of the following management strategies would have the greatest impact on this patient’s prognosis?