During a hospital night shift, a physician assesses a newly admitted patient reporting worsening breathlessness and the inability to sleep lying flat. The patient's medical background includes coronary artery stenting three years ago and a lengthy history of cigarette smoking. Bedside evaluation demonstrates elevated jugular venous pressure, a prominent S3 gallop, and bilateral basilar crackles. Oxygen saturation is 90% on ambient air. Which of the following is the most appropriate initial pharmacological intervention for this patient?
- Intravenous bumetanideAnswer
- BInhaled albuterol
- CIntravenous methylprednisolone
- DOral azithromycin
- EOral carvedilol
Answer
The most appropriate initial intervention is an intravenous loop diuretic such as bumetanide.
The clinical presentation of severe orthopnea, elevated jugular venous pressure, an S3 gallop, and bilateral basilar crackles in a patient with a history of coronary artery disease is highly specific for acute decompensated heart failure (ADHF). The immediate priority in managing ADHF is to relieve pulmonary congestion and optimize volume status. Intravenous loop diuretics, such as bumetanide, are the first-line therapy because they rapidly decrease intravascular volume and lower left ventricular filling pressures, thereby alleviating respiratory distress.
Step-by-Step Solution
Key Concept
Diagnosis and initial pharmacological management of acute decompensated heart failure.
Estimated Time:1m 0s