A 70-year-old female with a history of hypertension and obesity presents to the emergency department with acute dyspnea, orthopnea, and bilateral lower extremity edema. Her blood pressure is 180/100 mmHg, heart rate 105 bpm, respiratory rate 28 bpm. Lung auscultation reveals bilateral crackles. Echocardiogram shows left ventricular ejection fraction of 60% with evidence of left ventricular hypertrophy and diastolic dysfunction. What is the most appropriate initial management?
✓ Correct Answer: Option B
This patient has acute decompensated heart failure with preserved ejection fraction (HFpEF), presenting with congestion and hypertension. Initial management focuses on reducing preload and afterload with intravenous diuretics and vasodilators to relieve congestion and control blood pressure. Dobutamine is for systolic dysfunction.