11-20-2006, 05:41 PM
A 77-year-old man presents with decreasing exercise tolerance. Just 1 year earlier, he was able to play doubles tennis for 2 hours. Over the past few months, however, he has had progressive dyspnea on exertion and now can walk only two blocks on level ground before becoming short-winded. He has also been awaking from sleep with shortness of breath and requires three pillows to sleep comfortably. He has a history of rheumatic fever as a teenager. On physical examination, his blood pressure is 168/60 mm Hg, pulse is 92/min, and respirations are 18/min. He is afebrile. He has jugulovenous distention lying supine. He has bibasilar rales extending 1/4 up both posterior lung fields. He has a regular S1 and S2, with a blowing diastolic murmur heard at the aortic area, which is grade II/IV. An S3 is audible. The liver edge is mildly tender, and there is moderate lower extremity edema extending to both knees. Which of the following medications will most likely be effective in the management of his cardiac disorder?
A. Captopril
B. Coumadin
C. Digoxin
D. Furosemide
E. Isosorbide dinitrate
A. Captopril
B. Coumadin
C. Digoxin
D. Furosemide
E. Isosorbide dinitrate
