sarika
Forum Guru
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Posts: 1,200
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A 52-year-old Hispanic woman presents for an employment physical examination. The patient is a recent immigrant, and she hasn't seen a doctor for fifteen years. She denies chest pain or shortness of breath. She has good exercise tolerance and doesn't have a history of cardiac problems. The blood pressure is 165/70 mm Hg, and heart rate is 72/min. No jugulovenous distention is seen, and carotid bruits are absent. On heart examination, there is a normal S1, a physiologically split S2, a II/VI systolic ejection murmur at the base, and a III/VI diastolic decrescendo murmur at the left sternal border. This diastolic murmur is best heard when the patient holds her breath while sitting or leaning forward. Which of the following is most likely to benefit this patient?<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
(A) Digoxin
(B) Metoprolol
(C) Nifedipine
(D) Balloon manipulation
(E) Valve replacement
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| dr.wad
Forum Senior
Topics: 3
Posts: 350
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(A) DIGOXIN .
this aortic regurge. Digoxin will improve the cardiac contractility to overcome the volume overload on the heart.
valve replacement is indicated in marked symptoms , marked cardiomegaly, declining left ventricular functions below 50 % , acute aortic incompetence
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| prathapdoctor
Forum Elite
Topics: 12
Posts: 406
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YES,I agree that its aortic regurgitation, i will go for valve replacement, this is the definitive treatment and most effective.
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| prathapdoctor
Forum Elite
Topics: 12
Posts: 406
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i think the answer is NIFDIPINE here, for asymptomatci AR, the drug of choice is either calcium channel blockers or ACE inhibitors,
if the ejection fraction is less than 55% and if the end diastolic volume is more than 55 ml per m2, surgery is indicated irrespective of functional status.
in heart failure ACE inhibitors and digoxin are used.
so NIFEDIPINE is drug of choice here.
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| sarika
Forum Guru
Topics: 195
Posts: 1,200
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you are right nifedipine is correct
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