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Soru

Zorluk: KolayGeneral Internal Medicine

A 58-year-old female presents to an urgent care facility reporting progressively worsening shortness of breath over the last three days. She notes that she must prop herself up on multiple pillows at night to sleep comfortably. Her medical history includes long-standing type 2 diabetes mellitus, hypertension, and a 20-pack-year smoking history. Vital signs show a blood pressure of 162/94 mmHg, heart rate of 98/min, respiratory rate of 24/min, and oxygen saturation of 92% on ambient air. Physical examination reveals prominent jugular venous pulsations and fine bibasilar crackles on lung auscultation. Trace bilateral pedal edema is also present. Which of the following is the most appropriate initial pharmacological management for this patient's acute symptoms?

  1. Administration of an intravenous loop diureticCevap
  2. B
    Inhalation of a short-acting beta-agonist
  3. C
    Initiation of broad-spectrum oral antibiotics
  4. D
    Administration of systemic glucocorticoids
  5. E
    Initiation of a long-acting muscarinic antagonist

Cevap

Administration of an intravenous loop diuretic
The patient's presentation of progressive dyspnea, orthopnea (sleeping on multiple pillows), jugular venous distension, bibasilar crackles, and pedal edema is highly characteristic of acute decompensated heart failure with volume overload. The most appropriate initial management is the administration of an intravenous loop diuretic. This intervention provides rapid symptomatic relief by promoting diuresis and inducing mild venodilation, thereby reducing cardiac preload and resolving pulmonary congestion.

Adım Adım Çözüm

1
Analyze the patient's symptoms and physical exam findings.
The patient has orthopnea, jugular venous distension, bibasilar crackles, and pedal edema.
These are the classic signs of acute decompensated heart failure with volume overload.
2
Determine the most appropriate initial pharmacological intervention.
Intravenous loop diuretics (such as torsemide, bumetanide, or furosemide) should be administered.
Loop diuretics rapidly reduce cardiac preload and pulmonary congestion by promoting diuresis and venodilation, directly addressing the underlying mechanism of the patient's dyspnea.

Anahtar Kavram

Diagnosis and acute management of decompensated heart failure
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Konular

General Internal Medicine

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