11-20-2006, 04:02 PM
A 57-year-old woman with diabetes and nephrolithiasis is admitted to the medical services for evaluation of her chest pain that began when playing with her grandchild. She had a previous myocardial infarction and is status-post a three-vessel bypass two years prior. Her medications include atenolol, lisinopril, allopurinol, and atorvastatin daily. You are called to the patient's room because the patient is currently complaining of chest pain. She reports that while talking on the telephone, she became very angry with her daughter and developed chest pain.On arrival she is lying in bed and appears uncomfortable. She is diaphoretic and appropriately anxious.Her blood pressure is 190/110mm Hg and pulse is 110/min. She has an S4 gallop and scant bi-basilar rales. An electrocardiogram shows sinus tachycardia with a left axis deviation. Voltage criteria are met for LVH and there are STsegment depressions of 2.5mm in leads V1-V5. The most appropriate next step in management is to
A. administer verapamil, intravenously
B. give furosemide, intravenously
C. give morphine, intravenously
D. give nitroglycerin, intravenousl
E. obtain a chest radiograph
A. administer verapamil, intravenously
B. give furosemide, intravenously
C. give morphine, intravenously
D. give nitroglycerin, intravenousl
E. obtain a chest radiograph