Heart Failure
A 75-ycar-old man presents to the ED with diaphoresis and severe dyspnea. Initial assessment revealed the following:
A pulse oximetcr revealed 93% oxygen saturation. Laboratory work, including an arterial blood gas sample, was done with the following results;
Oxygen was initiated at 4 Umin via nasal cannula. An ECG was done and showed left ventricular hypertrophy and LBBB. His chest x-ray showed an enlarged cardiac silhouette and bilateral infiltrates.
A dobutamine infusion was started at 2.5 mcg/kg/min, and furosemide 40 mg IV was given. Cardiac cathctcrization was performed the next morning with the following findings:
Impaired myocardial contractility
What effect will the dobutamine infusion and the dose of furosemide have?
(A) Increase myocardial contractility and reduce ventricular prcload
(B) Increase myocardial contractility and reduce ventricular
after load
(C) Reduce myocardial contractility and increase ventricular preload
(D) Increase myocardial contractility and increase ventricular afterload
Following the initiation of dobuta.mine and administration of furo1emide, you would expect which of the following to occur?
(A) HR 120 beats/min; RR 36 breaths/min; Spo2 83%
(B) HR 110 beats/min; RR 24 breaths/min; Spo2 95%
(C) HR 95 bcats/min;JVD Bilateral 7-mm elevation;
RR 32 brcaths/min
(D) BP 105/80 mm Hg, HR 130 beats/min; Spo2 75%
Bued on the ECG and cardiac catheterization results, what additional intervention would benefit this patient?
(A) Implantation of a HeartMate II LVAD as destination therapy
(B) Ventricular aneurysmectomy/reconstruction surgery
(C) Mitra! valve repair
(D) Insertion of a dual-chamber biventricular pacemaker