chf - ben

[ArchivalUser]

A 72-year-old white man is seen in the clinic with complaints of increasing dyspnea on exertion and orthopnea. The patient recently moved to the city and has records of a recent hospitalization four months ago for dyspnea upon minimal activity, increasing fatigue, and orthopnea. The patient has a long-standing history of asthma and diabetes. Medications at this time include inhaled steroids, inhaled beta-agonists, and glyburide. ACE inhibitors and furosemide were started two months ago.

Vital signs are: pulse 100/min, respirations 24/min, and blood pressure 154/94 mm Hg. Cardiovascular examination reveals a regular rate and rhythm, and an S4 is present. Bibasilar crackles are evident in the chest. There is no wheezing. There is a trace bilateral pedal edema in the extremities, and routine labs are normal, except for a BUN of 42 mg/dL and a creatinine of 1.9 mg/dL. An EKG shows a sinus rhythm with left ventricular hypertrophy. Chest x-ray shows cardiomegaly and increased vascular congestion. Labs four months ago showed a BUN of 27 mg/dL and a creatinine of 1.2 mg/dL. Echocardiogram shows left ventricular hypertrophy and an ejection fraction of 57%.

What is the next step in management in the management of this patient?

(A) Increase the dose of furosemide
(B) Restrict salt and fluids and reschedule a return appointment in four weeks
© Increase the dose of ACE inhibitors
(D) Add digoxin
(E) Start the patient on carvedilol

pls explain ur answer

[ArchivalUser]

B? restrict salt and fluid, the only problem here is that reschedule an appointment in four weeks, the next appointment should be 1 wk or return if not improved within 2 days.

The next is probably carvedilol, b-blocker reduce mortality, carvedilol can reduce heart rate and blood pressure which is an important medication for heart failure with fast heart rate. The only problem for this pt is that he has long-standing asthma that is a contraindication for b-blockers.

[ArchivalUser]

guys which class of CHF does this Pt fall into and if so what is the appropriate Rx depending onthe Class I thru IV