Left Ventricular Ejection Fraction of 25%! - USMLE Forums
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  #1  
Old 04-16-2010
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Default Left Ventricular Ejection Fraction of 25%!

A 45-year-old man has a left ventricular ejection fraction of 25% (N>55%) with diffuse hypokinesis. He has a sedentary life-style. He eats red meat up to 6 times weekly and drinks 4 alcoholic beverages daily. He is 185 cm (6 ft 1 in) tall and weighs 86 kg (190 lb); BMI is 25 kg/m2. His blood pressure is 90/60 mm Hg. Coronary arteriography shows no evidence of atherosclerosis. To prevent further heart damage, which of the following is the most appropriate recommendation?

(A) Aerobic exercise program
(B) Avoidance of alcohol
(C) Ingestion of more vegetables and decrease in red meat intake
(D) Isometric/weight-training exercise program
(E) Weight loss
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  #2  
Old 04-16-2010
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Default WELL

if they are talking about decrease EF it means decrease SV which in an alcholic guy . Meaning he has DCM (DILATED CARDIOMYOPATHY) a proof for that is the hypotension. So i guess alcholic(risk factor for dcm=Even a big risk factor) + hypotension + systolic dysfunction. Decrease your alchol level and get better?
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Old 04-16-2010
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i think is B. Avoidance of alcohol.
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Old 04-16-2010
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I would like to grab the opportunity & ask you sth. Many times during studying for ck, I came across questions that asked about factors related to hypertension. In many among them, alcohol was considered the most important risk factor for arterial hypertension, whereas my intuition would push me towards smoking or salt consumption. What is your opinion, my dear fellows?
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Old 04-16-2010
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@ ath.pantelis :
You are right,this is what same i also wanted to learn about.
How theoretically they write Alcohol as main cause though in daily diet SALT
& WATER are mostly ingested & even not all are having alcohol.......
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Old 04-17-2010
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same.....option B..w know HTN in alcholiciz manly due to obesity and poor renal status,as these 2 r undercontrol vth aGE 45....so b iz correct,among daily diet consumption,salt water input verses output balance iz met vth normal renal status
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Old 04-17-2010
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guys ALCOHOL CAUSES DECREASE RESPONSIVENESS TO ALPHA- ADRENERGIC RECEPTORS, THIS CAUSES AN INCRESE IN SYPATHETIC STIMULATION. ALSO THERE IS DIRECT VASOCONSTRICTOR EFFECT OF ALCOHOL ON MOST VASCULAR BEDS.... THIS IS "SLOW PRESSOR EFFECT"OF ALCOHOL....

MOREOVER, WITHDRAWAL OF ALCOHOL CAUSES SEVERE HYPERTENSION WITH INC. BLOOD CONCENTRATION OF NORADRENALINE, RENIN, ALDOSTERONE AND CORTISOL....

ALSO, There are cited effects of alcoholic beverages on fibrinolysis, blood lipids, and lipid peroxidation seem more likely related to protective effects against atherothrombotic conditions, but the idea of relative benefit for HTN via these mechanisms is intriguing



NEHOW HERE THE REASON IS CLEARLY DILATED CARDIOMYOPATHY.....
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Old 04-18-2010
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Default u're ryte guys

the answer is B

but dr.F i have a question regarding yr post.

u said alcohol causes decreased alpha adrenergic response to cause HTN. but increased alpha1 causes increased vascular smooth musle contraction, and decreased alpha 2 causes increased sympathetic response & at the same time increased insulin level. but doesnt alcohol cause acute pancreatitis hence decreased insulin levels?

so does it mean (from what u are saying), that alcohol causes decreased response to alpha 2 which causes increased sympathetic stimulated BUT has to effect in increasing insulin (as it is regulated by a decrease in alpha2 stimulation)

sigh...
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Old 04-18-2010
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I think the effect of alcohol to the pancreas is direct and mostly affects the exocrine part, causing self-digestion of the gland and chemical inflammation. I am not sure that the ANS has any substantial contribution to this process.
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