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Old 09-10-2012
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Default paeds CVS case

A 4-week-old infant presents with tachycardia, tachypnea, and poor weight gain. His arterial blood gas shows a pH of 7.34, a PaCO2 of 41 mm Hg, and a PaO2 of 74 mm Hg. A chest radiograph shows cardiomegaly. Echocardiography reveals a structurally normal heart, left ventricular dilatation, a left ventricular ejection fraction of 20%, and mild mitral and tricuspid regurgitation. IV administration of which of the following medications is the best initial step in management of this patient?

A. Angiotensin-converting enzyme inhibitor
B. Corticosteroid
C. Digoxin
D. Epinephrine
E. Furosemide
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  #2  
Old 09-10-2012
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nobody answers so ill give it a shot, he has decompensated heart failure and fluid overload due to that, he also has acute pulmonary edema because of the blood gases and the extremely low EF, so I would give Furosemide
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Old 09-10-2012
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ans A . i think ace inhibitors will prevent remodeling of heart and pt has Mr so it will decrease afterload and help in MR

furosemide will decrease preload and will not help much as pt already has a low ejection fraction so decreasing volume will have a negative impact ....
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The correct Answer is E.
This infant has acute congestive heart failure (CHF). CHF may be defined as inadequate contractile heart function for the specific hemodynamic needs. Clinical manifestations include respiratory distress, tachycardia and/or hyperdynamic precordium, and cardiac enlargement evidenced by echocardiogram. The differential diagnosis of CHF includes left-to-right shunt (ASD, VSD, PDA, atrioventricular canal, or AV fistula), left-sided obstruction leading to myocardial dysfunction (severe coarctation or AS), or intrinsic myocardial dysfunction (myocarditis, cardiomyopathy, or infarct due to anomalous coronary artery). In acute CHF, treatment should begin immediately. IV furosemide is the drug of choice because its onset is very rapid. It can provide quick symptomatic relief and improve respiratory distress.
Angiotensin-converting enzyme inhibitors (choice A) are used for the long-term management of patients with CHF. In adults, they have been proven to reduce mortality and improve symptomatic relief. Although data are not available for children, they have been reported to improve hemodynamic functions.
Corticosteroids (choice B) may be useful in myocarditis but have no role in CHF per se.
Digoxin (choice C) requires a longer time to take effect on CHF, and it has only a modest influence on myocardial function.
Epinephrine (choice D) is not used in the treatment of CHF.
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E. Furosemide

He has systolic heart failure. Furosemide is the best initial step in management of this patient.
ACEI should be the next for long term management.
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