robin082006
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A 76-year-old male presents for the evaluation of progressively worsening dyspnea. He complains of dyspnea at rest. He denies any chest pain, cough or ankle edema. He does not smoke or drink alcohol. His past medical history is insignificant and he denies any asthma, COPD, diabetes mellitus and coronary artery disease. He does not take any medication. He has essential HTN. Examination of his precordium shows a non-displaced, heaving apical impulse. Cardiac auscultation shows an S4 gallop. Auscultation of lungs shows bilateral basal crepitations. Chest X-ray shows normal cardiac silhouette and pulmonary infiltrates. EKG shows evidence of left ventricular hypertrophy. Echocardiography shows normal left ventricular end-diastolic volume and normal ejection fraction. Which of the following is the most appropriate pharmacological measure in this patient?
A. Beta-blockers
B. Calcium channel blockers
C. Digoxin
D. Diuretics
E. ACE inhibitors
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| Aashi
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Normal LV size with S4 + pulmonary crackles and infiltrates---->diastolic dysfunction of left heart----> give beta blockers
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| prathapdoctor
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in this case all the features are suggestive of diastolic dysfunction except the end diastolic volume in this case is normal,which is against diastolic dysfunction.
in this case i will go with diuretics,thinking as fluid overload leading to pul edema.
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| drashishmahajan
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i ll go with E... aashi dont u think tht the b blocker will further decrease the heart rate n potentiate the problem...in this case the heart is hypertrophic n S4 is present t.. i agree there the dystolic dysfxn... but to dec the pre load n the after load ... use ACE inhibitor
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| Mahwish Mushtaq
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in this case the patient doesn't have Diabetes so i'll go with beta blockers.
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| CocaCola
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Patient has LVH due to long standing hypertension leading to diastolic dysfunction...
A - beta blockers
Beta blockers slows the rate and allows better filling of the ventricles...
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| robin082006
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this is isolated diastolic dysfunction.
Answer is beta Blocker
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| prathapdoctor
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but robin do you think that end diastolic volume will be normal in distolic dysfunction,correct me if i am wrong.
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| CocaCola
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LVEDV is more specific for systolic dysfunction... when the left ventricle isn't able to empty it's contents then end diastolic volume is increased...
Diastolic dysfunction just indicates there is a problem with filling the ventricle - LVEDV could be normal...
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There is one thing we can do, and the happiest people are those who can do it to the limit of their ability. We can be completely present. We can be all here. We can give all our attention to the opportunity before us!!!
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| prathapdoctor
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i think LVEDV will be decreased in diastolic dysfunction,let me check that.
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| webjeee
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E
why beta blocker? dyspnea! I don't know if beta blocker will worsen it.
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| beathricce
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can anyone explain me , or tell me what is the key to differenciate sistolic and diastolic disfunction?
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| prathapdoctor
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in diastolic heart failure - the end diastolic pressure will be high in ventricles with normal enjection fraction,any heart failure with greater than 50% must be considered as diastolic heart failure.
restrictive cardiomyopathy,HOCM classically produce diastolic heart failure but chronic hypertensive heart disease and AS will produce diastolic dysfunction.
in systolic heart failure,end diastolic volumes will be high and ejection fraction will be low,many heart failures are because of systolic failure only.
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| prathapdoctor
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any heart failure with more than 50% ejection fraction is diastolic heart failure.
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