MDcooper
Forum Guru
Topics: 211
Posts: 470
|
71-year-old man presents to his physician 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
___________________
live and let live.
|
| prathapdoctor
Forum Elite
Topics: 12
Posts: 406
|
because the patient is in failure with atrial fibrillation,i will go with digoxin therapy.
|
| doc_clotaire
Forum Guru
Topics: 159
Posts: 1,265
|
I also think that The answer is D .
It 's either B-Blockers or Digitalis , since the patient has Congestive Heart Failure and AF at the same time , we should give him initiate Digoxin Therapy
___________________
The elevator to succes is broke ,you must take the stairs
|
| robin082006
Forum Hero
Topics: 471
Posts: 5,123
|
I go with D too.
But we should check electrolytes firstly.
___________________
The Key to Succeed is Patience.
|
| krsna
Forum Senior
Topics: 1
Posts: 211
|
i think its D
|
| sarika
Forum Guru
Topics: 195
Posts: 1,200
|
i would also choose digoxin due to presence of CHF...but what about the saying that goes Beta blocker effects overall mortality and digoxin doesnt in CHF....and acc to books we can choose either digoxin or beta blocker....while using calcium channel blockers on short term basis?
|
| Guptashutosh
Forum Elite
Topics: 35
Posts: 354
|
wel why r u guys ignoring Amiodaron , it is anti arrhythmic as wel as ionotropic
actually it s personnel exp as we treat a lot of pt with AF with Amiodaron , so i`ll go with amiodaron if i have a choice over here....
digoxin is notorios for arrhythmias and toxicity and one more thing here is pt is getting thiazides which causes hypokalemia potentiating digoxin toxicity
Good Luck
|
|
| |
| | | | | | | |
