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Zorluk: KolayPharmacologic Interventions

A 65-year-old man presents to the emergency department with a 2-day history of progressively worsening dyspnea, orthopnea, and a cough productive of pink, frothy sputum. He has a past medical history of an anterior myocardial infarction three years ago, subsequent heart failure with reduced ejection fraction, and essential hypertension. His home medications include oral lisinopril, carvedilol, and low-dose aspirin. Upon arrival, his temperature is 37.0°C (98.6°F), blood pressure is 155/90 mm Hg, pulse is 112/min, and respiratory rate is 26/min. Pulse oximetry shows an oxygen saturation of 88% on room air. Physical examination reveals elevated jugular venous pressure, an S3 gallop, and diffuse bilateral crackles on lung auscultation. An electrocardiogram shows sinus tachycardia without acute ST-segment or T-wave changes. Which of the following is the most appropriate immediate pharmacologic intervention?

  1. Intravenous furosemideCevap
  2. B
    Intravenous metoprolol
  3. C
    Intravenous 0.9% sodium chloride
  4. D
    Intravenous heparin
  5. E
    Oral amiodarone

Cevap

Intravenous furosemide
The correct intervention is intravenous furosemide. This patient is presenting with classic signs of acute decompensated heart failure (ADHF) complicated by pulmonary edema, as evidenced by his progressive dyspnea, frothy sputum, hypoxia, elevated jugular venous pressure, S3 gallop, and diffuse crackles. The immediate priority in managing ADHF with volume overload is to reduce ventricular preload and alleviate pulmonary congestion. Intravenous loop diuretics, such as furosemide, are the first-line pharmacologic intervention for this purpose. They act quickly to induce diuresis and also have an early venodilatory effect that reduces venous return to the heart even before the onset of significant urine output.

Adım Adım Çözüm

1
Analyze the patient's clinical presentation and physical exam findings.
The patient presents with severe dyspnea, hypoxia, frothy sputum, elevated jugular venous pressure, an S3 gallop, and bilateral crackles.
To establish the primary diagnosis of acute decompensated heart failure (ADHF) with pulmonary edema.
2
Evaluate the patient's most urgent physiological derangement.
The patient is severely volume overloaded and hypoxic, requiring rapid diuresis and reduction of pulmonary fluid.
To guide the immediate stabilization of the patient's respiratory and hemodynamic status.
3
Select the appropriate pharmacologic agent for initial stabilization.
Intravenous furosemide is selected as the primary intervention.
Loop diuretics rapidly decrease intravascular volume and venous return (preload), effectively relieving acute pulmonary edema.

Anahtar Kavram

First-line pharmacologic management of acute decompensated heart failure with pulmonary edema.
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Pharmacologic Interventions

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