Sponsored Links
Results 1 to 5 of 5

Thread: Cardio#2

  1. #1
    IMG SURVIVOR's Avatar
    IMG SURVIVOR is offline Moderator 536 points
    Join Date
    Jan 2006
    Location
    NY
    Posts
    5,842
    Downloads
    43
    Uploads
    0
    Blog Entries
    29
    Thanks
    0
    Thanked 0 Times in 0 Posts

    Cardio#2

    Advertisements



    A 60-year-old man is hospitalized after he is taken to the emergency department because of dyspnea and leg edema. He has a longstanding history of essential hypertension that is treated with a thiazide diuretic and amlodipine. Coronary angiography performed 1 year ago because of chest pain was normal, but left ventriculogram showed an ejection fraction of 45%. On admission, blood pressure is 180/100 mm Hg and heart rate is 110/min and regular. Jugular venous distension is 10 cm while the patient is lying on a stretcher with his head elevated at 45 degrees. He has a positive hepatojugular reflex, 2+ pitting leg edema to the knees, soft S1 and S2, an S3 gallop, and diffuse pulmonary crackles. No heart murmurs are auscultated. Echocardiogram shows left ventricular ejection fraction of 20% and left ventricular end-diastolic dimension in diastole of 7 cm. He has 1+ mitral and 1+ tricuspid regurgitation with an estimated right ventricular systolic pressure of 40 mm Hg. Electrocardiogram shows a left bundle branch block. Serum electrolytes and hepatic and renal function measurements are normal. Acute ischemic syndrome is excluded by repeated measurements of cardiac enzymes. He receives furosemide, three boluses of 60 mg intravenously, and nesiritide over a 24-hour period and improves rapidly with diuresis of 2200 mL. Which of the following drugs should be initiated before discharge to improve long-term survival in this patient?
    A. Digoxin
    B. Furosemide
    C. Carvedilol
    D. Lisinopril
    E. Spironolactone
    Moderator: USMLE AND Residency Forums.

    Hidden Content
    why even bother with the obvious. Just know where you are need it and where you can help the most.

  2. #2
    pterygomandibularraphe is offline Junior Member
    Join Date
    Jun 2005
    Posts
    50
    Downloads
    7
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts
    C or D??? i think they both reduce mortality

  3. #3
    bergkamp is offline Newbie 510 points
    Join Date
    Mar 2008
    Posts
    2
    Downloads
    0
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts
    ee???is it?

  4. #4
    durreshahwark is offline Newbie 510 points
    Join Date
    Apr 2006
    Posts
    6
    Downloads
    9
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts

    lisinopril

    Cuz ACEIs dec mortality in pts with low EFS.

  5. #5
    IMG SURVIVOR's Avatar
    IMG SURVIVOR is offline Moderator 536 points
    Join Date
    Jan 2006
    Location
    NY
    Posts
    5,842
    Downloads
    43
    Uploads
    0
    Blog Entries
    29
    Thanks
    0
    Thanked 0 Times in 0 Posts
    The correct answer is D
    Educational Objectives
    Recognize the best strategy for drug implementation at discharge in a patient who is hospitalized because of decompensated congestive heart failure.
    Critique
    Although this patient requires therapy with multiple drugs, treatment with an ACE inhibitor should be initiated. ACE inhibitors are root agents to which β-blockers are added to reduce the rates of mortality and morbidity in patients who have congestive heart failure and systolic left ventricular dysfunction. β-blockers are usually started on an outpatient basis once the dose of ACE inhibitor is optimized and the patient is considered euvolemic. More recently, efforts have been mounted to validate the safety of also starting β-blockers in the hospital. This patient requires diuretics to achieve and maintain euvolemia but diuretics do not improve survival. Long-term treatment with a cardiac glycoside, such as digoxin, has no apparent effect on mortality in this situation. However, when coupled with ACE inhibitors, these agents reduce the incidence of deterioration and hospitalization associated with heart failure. Aldosterone antagonists should be reserved for older patients who have persistent New York Heart Association class 3/4 symptoms and are receiving an aggressive baseline protocol, including digoxin, a diuretic, an ACE inhibitor, and a β-blocker. Because calcium channel blockers have no proven benefit in reducing morbidity and mortality rates in patients with systolic left ventricular dysfunction, amlodipine is not a first-line drug in this patient. Amlodipine can be an adjunctive antihypertensive agent if blood pressure is not controlled after the patient is given the target doses of an ACE inhibitor and a β-blocker in combination with a diuretic.
    Moderator: USMLE AND Residency Forums.

    Hidden Content
    why even bother with the obvious. Just know where you are need it and where you can help the most.

Similar Threads

  1. Cardio#5
    By IMG SURVIVOR in forum Pathology Forum
    Replies: 4
    Last Post: 06-05-2009, 04:37 PM
  2. Hy 2545 Cardio Cardio Cardio!
    By tommyk in forum USMLE Step 1 Forum
    Replies: 0
    Last Post: 10-30-2006, 04:12 AM
  3. Cardio Q-1
    By Roxanita in forum Pathology Forum
    Replies: 4
    Last Post: 09-07-2005, 04:37 AM
  4. cardio 3
    By Asclepius1 in forum USMLE Step 1 Chats
    Replies: 0
    Last Post: 04-26-2005, 08:40 PM
  5. cardio 2
    By Asclepius1 in forum USMLE Step 1 Chats
    Replies: 0
    Last Post: 04-25-2005, 08:53 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •