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Zorluk: KolayCardiovascular System

A 64-year-old woman comes to the emergency department complaining of severe difficulty breathing that has progressively worsened over the last 72 hours. She also reports a persistent nighttime cough and states she must prop herself up with three pillows to sleep without feeling like she is suffocating. Her medical history includes hypertension, type 2 diabetes mellitus, and a 35-pack-year smoking history. Her temperature is 37.1°C (98.8°F), blood pressure is 162/94 mmHg, pulse is 108/min, and respirations are 24/min. Oxygen saturation is 92% on room air. Physical examination reveals distended neck veins when sitting at a 45-degree angle. Auscultation of the lungs demonstrates bibasilar crackles without wheezing. Cardiac auscultation reveals a regular rhythm, tachycardia, and a prominent S3 gallop. Examination of the lower extremities shows bilateral 2+ pitting edema extending to the mid-calves. Which of the following is the most appropriate initial pharmacological intervention for this patient?

  1. Intravenous furosemideCevap
  2. B
    Inhaled albuterol and ipratropium
  3. C
    Intravenous methylprednisolone
  4. D
    Oral levofloxacin
  5. E
    Intravenous ceftriaxone and azithromycin

Cevap

Intravenous furosemide
This patient presents with classic signs and symptoms of acute decompensated heart failure (ADHF), including orthopnea (needing pillows to sleep), paroxysmal nocturnal dyspnea (nighttime cough), elevated jugular venous pressure, an S3 gallop, bibasilar crackles, and peripheral edema. The most appropriate initial pharmacological intervention for a patient with volume overload due to ADHF is a loop diuretic, such as intravenous furosemide. This medication rapidly reduces intravascular volume and ventricular preload, thereby alleviating pulmonary congestion and improving respiratory symptoms.

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1
Analyze the patient's presenting symptoms and physical exam findings.
The patient has orthopnea, paroxysmal nocturnal dyspnea, elevated jugular venous pressure, an S3 gallop, bibasilar crackles, and bilateral pitting edema.
Identifying the specific symptom cluster is necessary to differentiate the cause of acute dyspnea.
2
Synthesize findings to establish the most likely diagnosis.
The combination of symptoms and signs is highly specific for acute decompensated heart failure with volume overload.
While the patient has a smoking history, the absence of wheezing and the presence of clear fluid overload markers (JVD, S3, edema) point away from pulmonary causes.
3
Determine the most appropriate immediate pharmacological management for the established diagnosis.
Intravenous furosemide (a loop diuretic) should be administered.
Loop diuretics provide rapid diuresis, decreasing intravascular volume and relieving the acute pulmonary congestion causing the patient's distress.

Anahtar Kavram

Diagnosis and initial pharmacological management of acute decompensated heart failure.
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Konular

Cardiovascular System

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