01-30-2010, 10:05 PM
A 60-year-old woman comes to your office with complaints of progressive fatigue. She is unable to make it through the day without tiring and hasn't been sleeping well due to waking up in the middle of the night short of breath. She is also concerned about a 10-pound weight gain over the past month. She has a past medical history of hypertension, hypercholesterolemia, and diabetes mellitus. Her medications include metformin, atenolol, hydrochlorothiazide, and atorvastatin. The doses haven't changed over the past two years. Vital signs are: blood pressure 167/96 mm Hg, heart rate 78/min, and respiratory rate 20/min. There is some mild jugular venous distension at 30 degrees, bibasilar rales, a holosystolic murmur at the apex radiating to the axilla, and a mild pitting edema of the ankles. Which of the following would be appropriate at this time?
(A) Echocardiogram
(B) Digoxin
© Increase the dose of atenolol
(D) Start ACE inhibitors
(E) Stop the atenolol
(A) Echocardiogram
(B) Digoxin
© Increase the dose of atenolol
(D) Start ACE inhibitors
(E) Stop the atenolol