Cardio 19-36 - ben

[ArchivalUser]

A 65-year-old white female, with chronic congestive heart failure, was admitted for community-acquired pneumonia. She is receiving aspirin, digoxin, furosemide, levofloxacin, and oral simvastatin. She is feeling better and her pneumonia is resolving. While planning for discharge she developed recurrent sustained ventricular tachycardia with stable vital signs during the nighttime. The patient has recieved amiodarone and now is stable in sinus rhythm. A recent echocardiogram showed an ejection fraction (EF) of 35%. What is the most important next step in the management at this stage?

A. Add beta blocker
B. Add spiranolactone
C. Measure serum electrolytes
D. Stop simvastatin
E. Discharge the patient

[ArchivalUser]

a??????

[ArchivalUser]

this pt need inotropic agent, EF is <55% or need to reduce preload by spironolacotone ?

B ?

[ArchivalUser]

b.........

[ArchivalUser]

agree with triplehelix exlanation

[ArchivalUser]

my answer is C....

because before starting any drug in CHF patient always do serum electrolytes....

[ArchivalUser]

kallastro! i think i agree with you too!! this is terrible i think since her V tach is is control now and since she's on furosemide and digox the MOST IMP step ought to be serum electrolytes cause probably that could have been the trigger for her arrhythmia in the first place..

[ArchivalUser]

When someone is having recurrent VT, first thing to do after stabilizing the patient is to search for underlying cause. This patient, most likely, has an electrolyte imbalance due to diuretics. Furosemide commonly causes hypokalemia, which may lead to digoxin toxicity. Therefore, ordering serum electrolytes and serum digoxin level is the most reasonable approach.

Adding a beta-blocker is a good thing for chronic heart failure but not the next step in this case.

Simvastatin has nothing to do with ventricular tachycardia.

Spironolactone is a potassium sparing diuretic that is not indicated at this stage