Aashi
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A 36-year-old woman comes to the cardiology clinic with complaints of shortness of breath on minimal exertion, which has been getting progressively worse over the past seven months. Six months ago, she delivered twins. For the last month of pregnancy, she felt short of breath after walking one block and noticed mild ankle edema, which she attributed to the natural course of pregnancy. After delivery, these symptoms became progressively worse. Now she also describes nocturnal dyspnea and states that lately she uses at least three pillows to sleep and cannot lie down flat at all. This was her fourth pregnancy, and her past medical history is unremarkable. She is trying to be compliant with fluid restriction. Her medications at this time are carvedilol, lisinopril, and furosemide.
The patient presents as an obese female, who is mildly short of breath at rest. Physical examination findings are positive for distended jugular veins, the presence of an S3 gallop, and a III/VI systolic ejection murmur radiating to the axilla. There are mild crackles at both lung bases, as well as a 1+ lower extremity edema. Echocardiogram was done three months ago, and showed an ejection fraction of 27% and a moderately dilated left ventricle and left atrium.
What would be most effective way to improve this patient's prognosis?
(A) Increase dose of diuretics
(B) Add hydralazine
(C) Cardiac catheterization
(D) Myocardial biopsy
(E) Cardiac transplantation
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| prathapdoctor
Forum Elite
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she is in post partum dilated cardiomyopathy with stage 4 heart failure and there has not been much improvement with ACE inhibitors and diuretics,so i will go with cardiac transplantation.
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| MDcooper
Forum Guru
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pt has two pbs.
1.dilated heart failure
2.mitral regurge
she is on medications and salt restriction.Her ejection fraction is extremly low besides ACE inhibitor use.she needs serious intervention with heart transplant
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live and let live.
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| robin082006
Forum Hero
Topics: 471
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E
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The Key to Succeed is Patience.
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| Aashi
Forum Moderator
Topics: 113
Posts: 1,061
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YUP...TRANSPLANT
___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."
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