04-11-2011, 10:07 PM
A 35-year-old woman (gravida 1, para 0) presents to the emergency room at 32 weeks of pregnancy with complaints of progressive shortness of breath over the last week and paroxysmal nocturnal dyspnea for the last 3 weeks. The patient states that she recently started to use three pillows during sleep. The patient has a history of atrial fibrillation and uses digoxin for rate control. She got married two years ago and has been unable to conceive for more than one year. Her pulse is 120/min and irregular, and her blood pressure is 130/85 mm Hg. Physical examination reveals jugular venous distension, bibasilar lung crackles, a loud S1, an opening snap following S2, and a low-pitched diastolic murmur best heard in the left lateral decubitus position.
In the emergency department, the patient receives oxygen via nasal canula, furosemide 80 mg intravenously, and diltiazem 20 mg intravenously with no significant improvement in her symptoms. Echocardiography shows normal left ventricular systolic function with a mitral valve area of 0.9 cm2.
Which of the following is the most effective therapy in her management?
(A) Initiate therapy with lisinopril
(B) Start metoprolol
© Balloon valvuloplasty
(D) Cesarean section
(E) Increase the dose of digoxin
In the emergency department, the patient receives oxygen via nasal canula, furosemide 80 mg intravenously, and diltiazem 20 mg intravenously with no significant improvement in her symptoms. Echocardiography shows normal left ventricular systolic function with a mitral valve area of 0.9 cm2.
Which of the following is the most effective therapy in her management?
(A) Initiate therapy with lisinopril
(B) Start metoprolol
© Balloon valvuloplasty
(D) Cesarean section
(E) Increase the dose of digoxin