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dr.roh Forum Guru Topics: 159 Posts: 361	09/26/07 - 04:40 PM             #1 66 y.o. man with History of Bacterial endocardits presents to outpt. clinic complaining of SOB. He has Paroxsymal Nocturanl Dyspnea & Orthopnea. On physical examination the patient is comfortable at rest. There is no JVD or pedal edema. Both lung fields show scattered wheezes. He also has Mitral Regurg. ECG is normal. Echo. shows Ejection fraction of 55%. What is the next best step in management? A. Digoxin B. Enalapril C. Heart Transplant D Hydrochlorothiazide E. Metoprolol F. Valve Replacement G. Warfarin
starcraftbw Forum Senior Topics: 13 Posts: 166	09/26/07 - 04:50 PM             #2 Heart transplant??? j/k...............i'll say Valve replacement F
dr.roh Forum Guru Topics: 159 Posts: 361	09/26/07 - 04:51 PM             #3 Normal Ejection fraction is 60% + or - 5% right?
starcraftbw Forum Senior Topics: 13 Posts: 166	09/26/07 - 04:59 PM             #4 ^^i am not so sure >55% is normal.... EF = Stroke volume/end diastolic pressure
bigdino Forum Newbie Topics: 2 Posts: 16	09/26/07 - 04:59 PM             #5 D Hydrochlorothiazide to relieve the pulmonary edema?
dr.roh Forum Guru Topics: 159 Posts: 361	09/26/07 - 05:03 PM             #6 The answer is F. *but I thought it would be (A) Digoxin Why F?? *the diagnosis is Left-sided Heart failure with Mitral Regurg. ------------------------------------------------------------------- If it was mitral regurg. by it self....than I would start off with medical TX 1st---Diurectic, ACEI, Digitalis right??....if medical fails than 2nd Surgery ------------------------------------------------------------------------- --- So because its Heart Failure with Mitral Regur......I would go directly to surgery??
dr.roh Forum Guru Topics: 159 Posts: 361	09/26/07 - 05:39 PM             #7 ok... (1) So Heart failure & MR.....if EF < 60%.....NEXT? Valve replacement (2) Heart failure & AR.....if EF < 55%.....NEXT? Valve Replacement ------------------------------------------------------------------------- ------------------- ** so this the explanation from kaplan for reason to skip medical TX and go to surgery ------------------------------------------------------------------------- -------- So if this comes up on the exam..............should I go with kaplan??
starcraftbw Forum Senior Topics: 13 Posts: 166	09/27/07 - 06:18 AM             #8 just think it simple, with MR *Acute acquired (CHF + new MR) --> surgery *Chronic: valve replacement when symptoms get worsen, or decrease EF

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