03-03-2008, 07:19 AM
A 76-year-old man with a long-standing history of congestive heart disease has been successfully maintained on a regimen of diuretics, beta-blockers, digoxin, and ACE-inhibitors. He reports occasional palpitations and his beta-blocker regimen is changed; atenolol is increased to 50 mg per day. Two weeks later, the patient comes to the clinic complaining of increased shortness of breath and leg swelling. His medications now include furosemide, 20 mg daily, digoxin, 0.25 mg daily, lisinopril, 40 mg daily, and atenolol, 50 mg daily. His blood pressure is 100/60 mm Hg and his pulse is 48/min. He has crackles in both lungs. Jugular venous distention is 12 cm of water. He has 2+ edema. Which of the following is appropriate management at this time?
A. Advise the patient to reduce his salt intake
B. Decrease the dose of atenolol
C. Increase the dose of digoxin
D. Increase the dose of furosemide
E. Increase the dose of lisinopril
A. Advise the patient to reduce his salt intake
B. Decrease the dose of atenolol
C. Increase the dose of digoxin
D. Increase the dose of furosemide
E. Increase the dose of lisinopril