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Discussion Starter · #1 ·
A 68-year-old man with no previous medical problems presents to clinic with shortness of breath and swelling of his ankles. Symptoms have progressed over the past few months. On physical examination, the patient has a regular heart rate and rhythm, an S4 is heard on cardiac auscultation, and inspiratory rales are heard throughout the lower half of the lung fields. Also, 2+ pitting edema is evident over the tibial surfaces. Echocardiography reveals an ejection fraction of 60%. Which of the following is most likely to improve this patient’s condition?
(A) Amiodarone
(B) Atorvastatin
(C) Digoxin
(D) Metoprolol
(E) Nitroglycerin
 

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It seems to be HF with preserved EF... so we must go for nitroglycerin to improve the dyspnea... alternatively a diuretic can also be used... then we must go on to find out the underlying pathology n treat it
 

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I think the answer is D because the patient has a diastolic dysfunction so you treat with a Beta blocker (Metoprolol) and with diuretics (which are not given as answers).
 

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Discussion Starter · #5 ·
Correct answer is D

You have to give the patient a beta blocker to control his heart rate to improve his diastolic filling. This patient is having diastolic failure not systolic failure as evidenced by the normal ejection fraction.
 
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