A 73-year-old man who has atrial fibrillation has been treated pharmacologically for 10 years. He presents to his primary care physician complaining of generalized dyspnea. Pulmonary function tests show forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) are both less than 70% of the predicted value, with a ratio of FEV1 to FVC of 81%. The flow-volume curve is shown in the image. Which of the following is a possible etiology of this presentation?
A Adult-onset asthma
B Amiodarone
C Diltiazem
D Sotalol
E Tobacco
The correct answer is B. This is a clinical picture of restrictive lung disease; the FEV1:FVC ratio is approximately normal, but both are dramatically reduced. Amiodarone is an antiarrhythmic that can cause pulmonary fibrosis, a restrictive lung disease.
Answer A is incorrect. Asthma is a cause of chronic obstructive pulmonary disease.
Answer C is incorrect. Diltiazem is an antiarrhythmic that is sometimes used in intravenous form to treat atrial fibrillation. It infrequently causes hypotension or bradyarrhythmias, but is not known to cause pulmonary fibrosis.
Answer D is incorrect. Sotalol has both α-blocking and action potential-prolonging activity. It is used for treatment of ventricular and supraventricular arrhythmias in children and for life-threatening ventricular arrhythmias in adults. It can sometimes cause torsades de pointes when taken at higher doses. However, sotalol does not cause pulmonary fibrosis.
Answer E is incorrect. Tobacco is a known risk factor for chronic obstructive pulmonary disease (COPD). COPD presents with an FEV1:FVC ratio of <80% and a sloping flow-volume curve.
feature of restrictive disease..go with amiodarone as it cause pulmonary fibrosis:indifferent:
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