Q of the Day - vanco

[ArchivalUser]

A 56-year-old man presents to the emergency department with complaints of dyspnea on exertion for the last three days. The patient is normally able to walk about eight blocks without any problems, but now can only walk one. He doesn't take any medications and denies alcohol and tobacco use. Vital signs are: temperature 98.7 F, pulse 126/min, blood pressure 124/68 mm Hg, and respirations 18/min. The jugulovenous pressure is elevated, and there is a soft diastolic rumble at the apex with an opening snap. Rales are present at both bases. EKG shows atrial fibrillation at a rate of 126/min. What is the next best step in the management of this patient?

(A) Furosemide
(B) Diltiazem
© Transesophageal echocardiogram
(D) Start coumadin
(E) Mitral valvotomy
(F) Electrical cardioversion

[ArchivalUser]

dd?

[ArchivalUser]

_ AAA > DD

[ArchivalUser]

aa is answer

as decreasing the preload would decrease load on left atrium.

[ArchivalUser]

a.....d

[ArchivalUser]

A FOLLOWED BY D

[ArchivalUser]

AA

[ArchivalUser]

cc

[ArchivalUser]

A, I think, treat pul congestion first: Dyspnoea, RR 18, Bi basilar rahles.

[ArchivalUser]

C to confirm Mitral!!