dr confused
Forum Senior
Topics: 66
Posts: 107
|
A 55-year-old man patient presents to your office complaining of increasing episodes of shortness of breath over the last 2 months. The patient claims he was in his usual state of health until two years ago, when he began to notice lower extremity swelling, which he attributed to being on his feet all day. Then approximately two months ago, he began to notice that he became short of breath episodically while lying down and needed to use more pillows. He also noticed that he had to stop after walking five to six blocks to catch his breath. The patient also claims that on occasion, when he gets up from bed, he feels lightheaded and dizzy for a short while. He denies any past medical history.
Physical examination reveals normal vital signs. Jugulovenous distention is present. There is an S3 and S4 gallop audible and evidence of a holosystolic murmur radiating to the axilla. The point of maximal impulse is at the fifth intercostal space in the midclavicular line. There are bilateral rales, and the abdomen shows ascites and hepatomegaly with edema of the extremities. The chest x-ray shows pulmonary congestion with no evidence of cardiomegaly. The EKG shows low voltage, with left-axis deviation and QS waves in the inferior leads. Echocardiogram reveals increased ventricular wall thickness, decreased left ventricular cavity size, and left atrial dilatation. Also noted is a sparkling granular myocardial texture in the interventricular septum.
What is the best treatment for this patient at this time?
(A) Pericardial stripping
(B) Heart transplantation
(C) Palliative and symptomatic
(D) Calcium-channel blockers
(E) Phlebotomy
|
| kpmle2
Forum Elite
Topics: 29
Posts: 290
|
(B) Heart transplantation
|
| elitoki
Forum Guru
Topics: 54
Posts: 508
|
D. Calcium channel blocker
I think this is Hypertropic cardiomyopathy that has prob on dyastole and impaired relaxation with relatively normal or slightly increase EF. Also on X-ray they have boot shaped heart.
Pls. let me know if I'm wrong. thanks~
|
| dr confused
Forum Senior
Topics: 66
Posts: 107
|
Answer:
(C) Palliative and symptomatic
Explanation:
In a patient with restrictive cardiomyopathy secondary to amyloidosis, the goal of the treatment is to treat the congestive symptoms. Heart transplantation is contraindicated because of the early recurrence of amyloidosis in the allograft. Pericardial stripping may be indicated as a treatment in a patient with constrictive pericarditis. Beta-blockers and calcium-channel blockers are relatively contraindicated owing to their selective binding to amyloid fibers. Phlebotomy is indicated if hemochromatosis was the underlying disease. Alkylating agents (such as melphalan) are only useful if the amyloid is secondary to plasma-cell disorders, such as myeloma.
|
| chemamr
Moderator and PGY1
Topics: 703
Posts: 4,441
|
nice question
___________________
Any time something is written against me, I not only share the sentiment but feel I could do the job far better myself.
|
| arlete
Intern in 2009!!!!!
Topics: 30
Posts: 2,208
|
___________________
When men make the rules, God decides the exceptions.
|
|
| |
| | | | | | |
