Based on the symptoms of Mr. Rowan is having shown that he is suffering from left ventricle dysfunction. It started with the decrease in the cardiac output, the venous pressure increases and causes the fluid to be leak out from the blood into the interstitial fluid. In the lung, the fluid leakage causes dyspnea due to pulmonary edema and a productive cough is a response in cleaning the fluid inside of the lung. The increase in the systemic venous pressure forces the extravasation of fluid to dependent tissues and leads to ankle edema. As the cardiac function is reclining, the blood flow in the kidney and the glomerular filtration rate decrease which make the blood to be distributed away from the kidney. But the blood flow improves when the body is at rest which would cause nocturia. When he goes for an echocardiogram, he was diagnosed with left ventricular hypertrophy. This is due to the heart remodeling mechanism, where the muscle thickens and was triggered by heart when there is an increased in the workload of the left ventricle.[1]
There are a few factors that could contribute to the development of Mr. Rowan’s symptoms. First is the age-related decrease in myocardial and vascular responsiveness to β-adrenergic stimulation that further impairs the ability of the cardiovascular system to respond to increased
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Rowan which I would agree with his choice as Metoprolol have more advantages than Carvedilol in terms of its pharmacokinetics. Metoprolol has less protein binding compared with Carvedilol, hence, it has a shorter half-life which means that it would stay in the body in a short time of period and lessen the side effects of the drug. Besides, the bioavailability of Metoprolol via oral route is higher than Carvedilol and makes Metoprolol have a higher efficiency compared with the latter. Last but not least, Metoprolol is much cheaper as compared with Carvedilol even though they the same therapeutic