fongch
Forum Elite
Topics: 71
Posts: 316
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Another Q from Kaplan Qbook. Please provide your reasoning in your answer. I do NOT want spend 5 minute typing just to get a single letter reply.
A 52-year-old man w/ a 30-pack-year history of cigarette smoking presents to a physician after moving to a new city. He was told that he had "high cholesterol" about 2 years ago, and he has a history of mild HT for which he has never been treated. He had a MI 6 months ago. His post-MI course has been uncomplicated, his exercise stress test was satisfactory, and he has experienced no subsequent chest pain. His medication include one aspirin tablet every other day. PE is normal except a S4. Which of the following is the most appropriate next step in management to prevent significant morbidity and mortality?
A Add a beta blocker
B Add enalapril
C Add nifedipine
D Increase the aspirin to one tablet three times daily
E Prescribe nitroglycerin for angina
Keep in mind to provide your reasoning when you reply. Thanks.
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| dr.wad
Forum Senior
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A _ add beta blocker.
i have no reason , but i know that beta blocker is the best drug that decrease mortality in patients with MI.
although im thinking also in enalapril , because there is S4 ( meaning heart failure ),
but still i go with beta blocker.
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| fongch
Forum Elite
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Posts: 316
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But this patient has lipid problem and beta blockers are known to disturb that aspect, right?
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| vradojc1
Forum Elite
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As dr.wad says, bud I'd reverse the order. And I think S4 here is result of hypertension.
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| arlete
Half way there!
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S4 happens because of atrial systole against a stiff ventricle (most probably because of long standing HTN in this case). S3 is the one that happens because of CHF, it sounds like a horse running.
The answer is beta-blocker, the reason is: scientifically stablished to improve morbibity and mortality in post MI patients. During the acute fase of MI, Aspirin is the one you give to decrease mortality.
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| doc_clotaire
Forum Guru
Topics: 159
Posts: 1,274
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A----------beta blockers
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