11-20-2006, 05:52 PM
A 60-year-old man presents with recurrent episodes of dyspnea on minimal exertion. He has a prior medical history significant for hypertrophic cardiomyopathy for 15 years, and for the past year his symptoms have become more severe and bothersome. He frequently complains of chest pain, orthopnea, nocturnal dyspnea, chronic nonproductive cough, weight gain, and peripheral edema. His medications include atenolol 50 mg BID, verapamil, disopyramide, and Lasix. Physical examination reveals an anxious tachypneic male who is afebrile with a blood pressure of 110/70 mm Hg without pulsus paradoxus. The respiratory rate is 30/min. Jugular veins are distended, and the heart sounds are distant. There are third and fourth heart sounds present, as well as bilateral rhonchi. The liver is enlarged, and pedal edema is present. The EKG shows nonspecific ST-T changes in the lateral leads. Chest x-ray reveals cardiomegaly with pulmonary congestion. The echocardiogram displays ventricular dilatation and mitral regurgitation with an ejection fraction of 35%. Three sets of cardiac enzymes are negative. What is the best medical management at this time?
(A) Add captopril to present regimen
(B) Increase the dose of Lasix and continue present regimen
© Stop the verapamil and disopyramide and start captopril
(D) Increase the dose of beta-blocker, verapamil, and Lasix; stop the disopyramide and start captopril
(E) Continue with present management
(A) Add captopril to present regimen
(B) Increase the dose of Lasix and continue present regimen
© Stop the verapamil and disopyramide and start captopril
(D) Increase the dose of beta-blocker, verapamil, and Lasix; stop the disopyramide and start captopril
(E) Continue with present management