A 56-year-old woman who is active and completely asymptomatic presents to your office for her…

A 56-year-old woman who is active and completely asymptomatic presents to your office for her routine evaluation and has the following findings: ? ECG: Regular sinus rhythm, rate 68 bpm, no conduction abnormalities ? Chest radiograph: Mildly enlarged LV, no pulmonary congestion ? Echocardiogram: EF of 30% Moderate LV dilatation The patient is otherwise normal, but has a family history of a mother who had sudden death at the age of 45 and a sister that was recently told of an enlarged heart. She has 3 children of childbearing age. Exercise stress testing revealed no evidence of coronary ischemia and her maximal oxygen consumption was 75% predicted. Further recommendation(s) should include: a. Digoxin, a diuretic, an ACE inhibitor, a beta blocker, genetic counseling, and ICD b. An ACE inhibitor, a beta blocker, genetic counseling, and ICD c. Genetic counseling, close follow-up, and initiation of therapy when symptoms of heart failure develop d. Transplant evaluation e. A biventricular pacemaker

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