Question of the Week # 163

163) A 62 year old man with past medical history significant for Congestive Heart Failure presents with progressively increasing shortness of breath over the past 2 months. He denies any chest pain on exertion or at rest. He was recently started on furosemide for management of peripheral edema and is compliant with low salt diet. An Echocardiogram obtained 3 months ago revealed an Ejection Fraction of 32% (Normal = above 55%) at which time he was started on Enalapril. On physical examination, there is trace ankle edema. There are no lung crackles on auscultation. Rest of the examination is normal. An EKG reveal changes of left ventricular hypertrophy with normal QRS duration. The most important intervention at this time that would most improve his survival is

A) Start Losartan

B) Start Carvedilol

C) Start Isosorbide and Hydralazine

D) Add Digoxin

E) Biventricular Pacing

7 Responses

  1. B

  2. Drugs reduce mortality in CHF

    1.Beta Blocker
    2.ACEI—-if EF<45%
    3.Spironolactone

  3. b

  4. E with EF below 35, he need cardiac resynchronization therapy (CRT)

    • Indication for CRT from clinical studies for the following characteristics: 1) Heart failure in NYHA functional class III or IV (if cardiac recompensation to class III is at least temporarily successful), 2) left ventricular ejection fraction 130 ms, particularly if left bundle branch block is present, 4) sinus rhythm

      • 1) Heart failure in NYHA functional class III or IV (if cardiac recompensation to class III is at least temporarily successful), 2) left ventricular ejection fraction 130 ms, particularly if left bundle branch block is present, 4) sinus rhythm

  5. E…….1) Heart failure in NYHA functional class III or IV (if cardiac recompensation to class III is at least temporarily successful), 2) left ventricular ejection fraction 130 ms, particularly if left bundle branch block is present, 4) sinus rhythm

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