Cardiomyopathy-Case 1 A 56-year-old man was admitted to the emergency room with shortness of breath. His chest x-ray revealed an enlarged heart and pulmonary congestion. His 12-lead electrocardiogram...

Cardiomyopathy-Case 1

A 56-year-old man was admitted to the emergency room with shortness of breath. His chest x-ray revealed an enlarged heart and pulmonary congestion. His 12-lead electrocardiogram (ECG) was consistent with left ventricular hypertrophy and his rhythm was atrial fibrillation (AF) with a ventricular rate of 102. Clinical findings included bilateral crackles auscultated one-third up from the bases, bilateral lower extremity, 4+ pitting edema to the midcalf, jugular venous distension (]VD), an 83, and a systolic murmur heard best at the apex. An emergency echocardiogram showed impaired contractility of the dilated left ventricle.

After the patient ia admitted and his diagno1i1 is confirmed, the initial priority for hi1 medical management is:

(A) Initiate inotropic support

(B) Obtain electroph)"liology consult for a biventricular pacemaker workup

(C) Administer a diuretic to reduce fluid overload

(D) Administer can>t':dilol to control the ventricular rate

The moet li1u:ly cause of a systolic murmur in thi1 patient i1:

(A) Aortic stenosis

(B) Mitral insufficiency

(C) Tricuspid stenosis

(D) Puhnonic insufficiency