An 82-year-old woman with a history of heart failure from coronary heart discase visits your office because she is having increasing symptoms. Her last visit was 4 months ago classified her as having NYHA class ll func onal status. Her ejection fraction is 35% She states that over the past 3 weeks she has gained 5kg, new onset of dyspnea while walking from her kitchen to her living room, which she used to do without difficulty. She has recently begun sleeping in a chair propped up because of difficulty breathing while lying flat. She takes valsartan 80 mg/d, sustamed-release metoprolol 50 mg/d, simvastatin 40 mg/d, and aspirin 81 mg/d, all of which she is tolera ng well. Her physical examination reveals an 8 Kg weight gain from her previously documented weight, a blood pressure of 118/74 mmHg, a heart rate of 63 bpm and regular, a respiratory rate 18 breaths/min, and a room air oxygen saturation of 96% at rest that decreases to 91% with hallway ambula on. She has VD. You hear basilar crackles in her lungs and her heart examination reveals a normal rhythm without murmurs or extra sounds. She has 1+ pi ng edema in her extremities. The next step in this patient's management is to?
سؤال مجاني 4 من 10 اليوم · اشترك وكمّل بدون حد
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الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: C. Add spironolactone to her regimen
HFrEF (EF 35%) worsening from NYHA II to class III (dyspnea walking within the house) while on an ARB and a beta-blocker → the next guideline step is to add an aldosterone antagonist (spironolactone). Options A/B mention drugs she is not taking (recall error), and oxygen is not indicated (SpO2 96% at rest). In practice she also needs a loop diuretic for the congestion, which is not offered.
ليش كل خيار صح أو غلط
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A
ليش غلط
Sacubitril/valsartan (ARNI) is used in EF <35% on a maximally tolerated ACEi or ARB; she is on valsartan alone, so replacing it with an ACE inhibitor is not the next step.
✓ Step-Up To Medicine 6th (HF).pdf · p. 8 -
B
ليش غلط
Metoprolol succinate, carvedilol and bisoprolol have all shown mortality benefit; swapping one for another does not address her worsening symptoms.
✓ Step-Up To Medicine 6th (HF).pdf · p. 9 -
C
ليش صح
Symptoms on minimal activity (NYHA class 3) on an ACEi/ARB and a beta-blocker call for adding an aldosterone antagonist such as spironolactone.
✓ (Y4)-(M B) HF.pdf · p. 5
- المصدر
- (Y4)-(M B) HF.pdf · p. 5
Step-Up To Medicine 6th (HF).pdf · p. 9 - المحاضرة
- Heart Failure · Cardiology · Module B
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