Question of the Week # 342

342) A 65 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 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. Crepitations are heard at bilateral lung bases and breath sounds decreased bilaterally.  A 2D echocardiogram reveals ejection fraction at 30% . An EKG reveals changes consistent with left ventricular hypertrophy. A Chest X-ray shows moderate pleural effusions bilaterally. Which of the following is the most appropriate next step in management of pleural effusion?

A) Intravenous Furosemide

B) Tube Thoracostomy

C) Tube thoracostomy followed by Pleurodesis

D) Needle thoracentesis

E) Implantable Cardioverter-Defibrillator (ICD) placement

7 Responses

  1. A) Intravenous Furosemide

    • B

  2. A

  3. A—-bilateral pleural effusion —treated with medication—-this is CHF

  4. A

  5. EF 30 ( most important) + LVH + CCF
    my answer is E

  6. All the medical management is given for CCF.
    No pulmonary edema on CXR.

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