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| * cardio Q, NOT NBME! .................Try this |
| | #531324 |
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A 72-year-old white man is seen in the clinic with complaints of increasing dyspnea on exertion and orthopnea. The patient recently moved to the city and has records of a recent hospitalization four months ago for dyspnea upon minimal activity, increasing fatigue, and orthopnea. The patient has a long-standing history of asthma and diabetes. Medications at this time include inhaled steroids, inhaled beta-agonists, and glyburide. ACE inhibitors and furosemide were started two months ago.
Vital signs are: pulse 100/min, respirations 24/min, and blood pressure 154/94 mm Hg. Cardiovascular examination reveals a regular rate and rhythm, and an S4 is present. Bibasilar crackles are evident in the chest. There is no wheezing. There is a trace bilateral pedal edema in the extremities, and routine labs are normal, except for a BUN of 42 mg/dL and a creatinine of 1.9 mg/dL. An EKG shows a sinus rhythm with left ventricular hypertrophy. Chest x-ray shows cardiomegaly and increased vascular congestion. Labs four months ago showed a BUN of 27 mg/dL and a creatinine of 1.2 mg/dL. Echocardiogram shows left ventricular hypertrophy and an ejection fraction of 57%.
What is the next step in management in the management of this patient?
(A) Increase the dose of furosemide
(B) Restrict salt and fluids and reschedule a return appointment in four weeks
(C) Increase the dose of ACE inhibitors
(D) Add digoxin
(E) Start the patient on carvedilol
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| * Re:cardio Q, NOT NBME! .................Try this |
| #2189004 |
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she is having B/l crackles after congestive HF,need to first alleviate Sx by nitrates or loop diuretics,she is already taking diuretics,now we should first increase dose of diuretics to remove water load..alleviate Sx then we can add other line of antiHTN t/t like beta blockers or on another line CCB etc..
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