USMLE Forum Archives - USMLE Step 2 CK - cardio
cardio
HIV - 07-01-08 22:30
A 75-year-old man presents to his doctor for follow-up of a recent emergency department visit. The patient has a 2-year history of mild congestive heart failure in the setting of long-standing hypertension. He reports that yesterday he sought care at the local emergency department for palpitations and shortness of breath. He was told that his heart was "fibrillating", but later, the fibrillation had "stopped on its own." His medications include a thiazide diuretic and an ACE inhibitor. On physical examination, he appears well and in no distress. His blood pressure is 130/80 mm Hg, and his pulse is 100/min and regular. His lungs have scant bibasilar rales, and no gallops are appreciated. He has a grade 2 holosystolic murmur heard best at the apex. His jugular venous pressure (JVP) is 10 cm at 30 degrees. An ECG taken in the office reveals atrial fibrillation at a rate of 94/min with normal ST segments.
Which of the following is the most appropriate next step in management?
A. Discontinue the ACE inhibitor
B. Initiate amiodarone therapy
C. Initiate beta blocker therapy
D. Initiate digoxin therapy
E. Initiate furosemide therapy
HIV - 07-01-08 22:30
A 75-year-old man presents to his doctor for follow-up of a recent emergency department visit. The patient has a 2-year history of mild congestive heart failure in the setting of long-standing hypertension. He reports that yesterday he sought care at the local emergency department for palpitations and shortness of breath. He was told that his heart was "fibrillating", but later, the fibrillation had "stopped on its own." His medications include a thiazide diuretic and an ACE inhibitor. On physical examination, he appears well and in no distress. His blood pressure is 130/80 mm Hg, and his pulse is 100/min and regular. His lungs have scant bibasilar rales, and no gallops are appreciated. He has a grade 2 holosystolic murmur heard best at the apex. His jugular venous pressure (JVP) is 10 cm at 30 degrees. An ECG taken in the office reveals atrial fibrillation at a rate of 94/min with normal ST segments.
Which of the following is the most appropriate next step in management?
A. Discontinue the ACE inhibitor
B. Initiate amiodarone therapy
C. Initiate beta blocker therapy
D. Initiate digoxin therapy
E. Initiate furosemide therapy
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#2
Re: cardio glacieres8401 - 08-03-08 08:04 D-
It has been shown that rate control is as good as rhythm control, and hence the answer is adding a beta blocker will help him achieve better rate control and have less episodes of ccf and less emergency visits.
#3
Re: cardio docleena - 08-08-08 11:47 A cold be the ans. since the pt is in CCF
beta blocker can give rise to tachycardia so wnt it worsen the condition
#4
Re: cardio sackatdoc - 08-09-08 05:17 this question is simply asking the drug of choice in atrial fib with CCF,and answer is DIGOXIN,coz it shall help in improving a fib as well as bibasilar rales in the chest, none other drugs will help in both.Beta-blockers like cardevilol, cardioselective are meant to be started for long term benefit,
Also from when have beta-blockers started causing tachy, yeah noncardioselectives are CI in CCF, for other reasons.
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