A 67-Year-Old Woman Comes to the Emergency Department with Swelling

A 67-year-old woman comes to the emergency department with swelling of her right eyelid and lips.  The swelling started an hour earlier and increased slowly until she became alarmed.  She reports no trouble breathing and has had no abdominal pain.  There is no associated itching or rash.  Her past medical history includes congestive heart failure due to nonischemic cardiomyopathy, hypertension, hyperlipidemia, and osteoporosis.  The patient's last left ventricular ejection fraction was 38%.  She is able to walk 3-4 blocks without shortness of breath.  Her current medications include furosemide, ramipril, simvastatin, and metoprolol succinate.  There is no family history of similar occurrences.
The patient's blood pressure is 130/80 mm Hg, pulse is 72/min, and respirations are 14/min.  Pulse oximetry is 98% on room air.  There is non-pitting edema of her right eyelid and upper and lower lips.  Cardiac examination reveals a 2/6 holosystolic murmur at the apex.  There is no stridor and lung examination is normal.  The remainder of the examination is within normal limits.
After observation and recovery, which of the following would be the best therapeutic option for this patient?

A) Continue current medications with careful outpatient follow-up
B) Decrease the dose of ramipril
C) Stop ramipril and start aliskiren
D) Stop ramipril and start enalapril
E) Stop ramipril and start losartan