neuroblastoma
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A 65-year-old white female, with chronic congestive heart failure, was admitted for community-acquired pneumonia. She is receiving aspirin, digoxin, furosemide, levofloxacin, and oral simvastatin. She is feeling better and her pneumonia is resolving. While planning for discharge she developed recurrent sustained ventricular tachycardia with stable vital signs during the nighttime. The patient has recieved amiodarone and now is stable in sinus rhythm. A recent echocardiogram showed an ejection fraction (EF) of 35%. What is the most important next step in the management at this stage?
A.Add beta blocker
B.Add spiranolactone
C.Measure serum electrolytes
D.Stop simvastatin
E.Discharge the patient
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| drdg
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C.Measure serum electrolytes
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| neuroblastoma
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why ejection fraction is 35%... do we care about it??/
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| neuroblastoma
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having recurrent VT, first thing to do stabilizing the patient
after that search for underlying cause.
This patient, most likely, has an electrolyte imbalance due to diuretic ( furesemide)
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| doc_clotaire
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Good Qs !
Actually furosemide -induced hypokalemia can increase Digoxin toxicity and give fatal arrythmias
I guess that s what happen to this poor woman 
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| sandra
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is it c?
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| neuroblastoma
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yes C
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| mildus
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I agree with you, furosemide eliminates K+, leading to hypokalemia which increases digoxin toxicity (among which it can cause VT)
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