A 76-year-old man with a history of heart failure visits your cline for a routine scheduled examination. He has underlying coronary heart disease, and his last echocardiogram 12 months ago revealed a le ventricular regional wall mo on abnormality in the anterior wall. His ejection fraction at that me was 40%. He takes lisinopril 20 mg/d, carvedilol 6.25 mg bid, atorvastatin 40 mg/d, and aspirin 81 mg/d, heart rate 82bpm and respiratory rate of 18 breath/min room air oxygen 96%. No jugular venous distension. His lungs are clear in all fields, and his heart examination reveals an S3 at the cardiac apex, which has been noted on previous examinations. He has no edema in his extremities. The next step in this patient's management is to?
سؤال مجاني 2 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: D. Document his current level of activity
He is stable on an ACE inhibitor + beta-blocker with no congestion (clear lungs, no JVD, no edema; the S3 is long-standing). In the lecture, HF drug steps are chosen by functional (NYHA) class, so the next step is to document his current activity level. Furosemide is for patients with dyspnea and crackles, and an ARB is only for ACEi intolerance (not added to an ACEi).
ليش كل خيار صح أو غلط
-
A
ليش غلط
Loop diuretics are given to patients with dyspnoea and lung crackles (acute congestion); his lungs are clear and he has no JVD or oedema.
✓ (Y4)-(M B) HF.pdf · p. 5 -
B
ليش غلط
An ARB is for patients who cannot tolerate ACEi (e.g. cough); he is on lisinopril without such problems.
✓ (Y4)-(M B) HF.pdf · p. 5 -
C
ليش غلط
Aspirin is indicated in all patients with CAD to reduce MI risk, so it should not be stopped.
✓ Step-Up To Medicine 6th (IHD & ACS).pdf · p. 7 -
D
ليش صح
HF drug steps are chosen by staging/NYHA class (symptoms on ordinary or minimal activity), so his current activity level must be documented first.
✓ (Y4)-(M B) HF.pdf · p. 5
- المصدر
- (Y4)-(M B) HF.pdf · p. 5
- المحاضرة
- Heart Failure · Cardiology · Module B
- ظهر في
- Cardio bank