07-11-2008, 12:20 AM
A 46-year-old woman with a history of complex congenital heart disease and cyanosis is evaluated for fatigue and dyspnea on exertion. The patient has had previous palliative surgical intervention but remains cyanotic. She has been managed conservatively for many years, with recent regular phlebotomies.
Physical examination demonstrates central cyanosis and digital clubbing. The apical impulse is laterally displaced. There is a parasternal impulse and brief systolic and diastolic murmurs are noted at the left sternal border. The lungs are clear.
Laboratory testing demonstrates a hemoglobin of 17.5 g/dL (175 g/L) and a hematocrit of 60%. The platelet count is 150,000/μL (150 × 109/L) and the leukocyte count is normal. A blood smear shows a hypochromic, microcytic anemia. The electrocardiogram demonstrates right ventricular hypertrophy with strain, unchanged from the last evaluation. The chest radiograph demonstrates cardiomegaly primarily affecting the right side of the heart and reduced pulmonary vascularity.
What is the most appropriate management of this patient at this point?
A Phlebotomy
B Short-course iron therapy
C Institution of vasodilator therapy
D Heart transplant evaluation
Physical examination demonstrates central cyanosis and digital clubbing. The apical impulse is laterally displaced. There is a parasternal impulse and brief systolic and diastolic murmurs are noted at the left sternal border. The lungs are clear.
Laboratory testing demonstrates a hemoglobin of 17.5 g/dL (175 g/L) and a hematocrit of 60%. The platelet count is 150,000/μL (150 × 109/L) and the leukocyte count is normal. A blood smear shows a hypochromic, microcytic anemia. The electrocardiogram demonstrates right ventricular hypertrophy with strain, unchanged from the last evaluation. The chest radiograph demonstrates cardiomegaly primarily affecting the right side of the heart and reduced pulmonary vascularity.
What is the most appropriate management of this patient at this point?
A Phlebotomy
B Short-course iron therapy
C Institution of vasodilator therapy
D Heart transplant evaluation