CardiologySite logo
Coronary Angio
Cardiology Quiz
Site Info
Site Map


clear1x1.gif clear1x1.gif
Prior Page Question AQ 006 Next Page

    A 56 year-year-old male was referred to you with progressive easy fatigueability, moderate exertional dyspnea and two pillow orthopnea of a 1 year duration.

   Relevant physical findings include BP 104/64 mm Hg, pulse 104/min and unlabored repirations at 20/min. Neck veins are engorged 3 cm above the clavicle at 30 degrees and the abdomino-jugular (also referred to as hepato-jugular) reflux is positive. The apical impulse is located two cm lateral to the left mid-clavicular line in the 6th interspace. Soft S3 and S4 gallops together with a grade 2/6 holosytolic murmur are heard at the apex. There are bibasilar inspiratory rales and 2+ pitting edema of the legs.

   Chest x-ray reveals moderate cardiomegaly with pulmonary congestion. EKG shows a sinus mechanism with a CLBBB and frequent unifocal premature ventricular contractions. Echocardiography reveals a left ventricular end-diastolic dimension of 62 mm with global hypokinesia, EF of 38% and moderate MR. The inferior vena cava is moderately distended and demonstrates poor inspiratory collapse

Which ONE of the following is initially indicated in the management of this patient?

Prior Page Exit Next Page
©1999-2007, A.S.M. Systems, Inc. All Rights Reserved, including design and all contents that include graphics and animations.