04-09-2012, 06:11 PM
A 78 year old man presents with progressively increasing shortness of breath. He has a 100 pack year history of smoking. His past medical history is significant for chronic obstructive pulmonary disease, coronary artery disease and congestive heart failure. He has been admitted several times in the past one year for Congestive heart failure exacerbations which resulted from his non-compliance with diet and medications. His medications include aspirin, metoprolol, enalapril, and spironolactone and tiotropium inhaler. On examination, he is afebrile with respiratory rate 24/min, pulse 106beats/min, blood pressure 140/90. Breath sounds are decreased and there is dullness to percussion on the left side of the chest. Heart sounds are regular and there is no S3 gallop. A 2D echocardiogram reveals ejection fraction at 30% and a brain natriuretic peptide 250 pg/ml (Normal less than 100pg/ml) . An EKG reveals changes consistent with left ventricular hypertrophy. A Chest X-ray is shown below:
http://ccsworkshop.com/blog/question-of-the-week-34-2/
Which of the following is the most appropriate next step in management?
A) Intravenous Furosemide
B) Tube Thoracostomy
C) Intravenos Nitroglycerin
D) Needle thoracentesis
E) Implantable Cardioverter-Defibrillator (ICD) placement
http://ccsworkshop.com/blog/question-of-the-week-34-2/
Which of the following is the most appropriate next step in management?
A) Intravenous Furosemide
B) Tube Thoracostomy
C) Intravenos Nitroglycerin
D) Needle thoracentesis
E) Implantable Cardioverter-Defibrillator (ICD) placement