USMLE Forum Archives - USMLE Step 2 CK - IM 34
IM 34
TheOne - 03-21-07 15:34
A 47-year-old man with a history of hypertension arrives to the emergency department complaining of severe chest pain. Laboratory studies and an EKG are consistent with an anterior wall myocardial infarction. He is given thrombolysis with complete resolution of symptoms. Echocardiography shows an ejection fraction of 50%. A pre-discharge stress test shows no symptoms or electrocardiographic evidence of ischemia with maximal effort. Two weeks later he comes to his physician's office to discuss further therapies. Which of the following therapies has been shown to increase survival in this situation?
A. Angiotensin-converting enzyme inhibitor
B. Beta blocker
C. Digoxin
D. Loop diuretic
E. Warfarin
TheOne - 03-21-07 15:34
A 47-year-old man with a history of hypertension arrives to the emergency department complaining of severe chest pain. Laboratory studies and an EKG are consistent with an anterior wall myocardial infarction. He is given thrombolysis with complete resolution of symptoms. Echocardiography shows an ejection fraction of 50%. A pre-discharge stress test shows no symptoms or electrocardiographic evidence of ischemia with maximal effort. Two weeks later he comes to his physician's office to discuss further therapies. Which of the following therapies has been shown to increase survival in this situation?
A. Angiotensin-converting enzyme inhibitor
B. Beta blocker
C. Digoxin
D. Loop diuretic
E. Warfarin
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#3
Re: IM 34
TheOne - 04-05-07 18:06 The correct answer is B. Beta blockers have been shown in multiple studies to improve
survival after myocardial infarction (MI) by decreasing both oxygen demand and the incidence of ventricular arrhythmia.
Angiotensin-converting enzyme (ACE) inhibitors (choice A), such as enalapril, have been shown to improve survival in post-MI patients who have ejection fractions less than 40%.
Digoxin (choice C) would be relatively contraindicated in this instance in that it would increase myocardial oxygen demand by increasing inotropy. This patient does not need positive inotropic support, as there is only minimal decrease in ejection fraction (normal 55% to 77%).
Loop diuretics (choice D) may help control this patient's hypertension, but they have not been shown to improve survival.
Warfarin (choice E) is beneficial in large anterior wall infarcts when there is a severely low injection fraction. The drug decreases the risk of thromboembolic phenomena.
#5
Re: IM 34 babbu5508 - 07-07-10 00:08 B. Beta blocker and ace inhibitors is the therapy that has been shown to increase survival in this case of past myocardial infarction....decreases myocardial workload
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