A 68-year-old woman presents with shortness of breath, fatigue, dry cough, and swelling in her ankles. Symptoms started around the time of her son's wedding 6 weeks ago, and she dismissed them as stress-related, but symptoms have worsened in intensity and frequency. Now she becomes very short of breath with any exertion, such as climbing stairs in her home. She feels like she may pass out and has to sit when she gets lightheaded. Her breathing is more difficult when lying down. She denies productive cough, fever, or chest pain. She has had no medical care for several years. Her past medical history is unremarkable, with no known medical conditions and no surgeries. She is menopausal and does not take any medications, nor does she have any allergies. She denies the use of tobacco, alcohol, and drugs. Vitals are: Pulse 101, BP 158/98, temperature 97.9 F, and BMI 28.5. BNP was elevated, Chest X-ray shows signs of perivascular edema/slightly enlarged cardiac shadow, EKG shows mild left ventricular hypertrophy. Echo is pending. What physical exam findings would be expected given this patient's history and test results?

Once this patient is stabilized and educated about her diagnosis and treatment, she asks what she could have done to prevent her condition. What represents the greatest modifiable contributing factor to this condition on a population basis?

What medication is recommended for this patient and, in large trials, has been shown to increase survival, reduce hospital admissions, and improve quality of life for patients with her current condition?