A 72-year-old woman has a 3 week history of weakness. Blood pressure 92/74 mm Hg, pulse 102/min/regular. Examination shows the apical impulse to be in the 6th intercostal space in the anterior axillary line. A 3/6 apical holosystolic murmur is heard. Which of the following medicines should not be taken by the patient? A. Lisinopril B. Hydralazine C. Furosemide D. Metoprolol E. Verapamil Answer: E • This patient is in systolic heart failure (SHF) related to low cardiac output from a dilated, feeble left ventricle • The primary medicinal therapy of SHF is a beta adrenergic blocker, angiotensin converting enzyme inhibitor (or angiotensin receptor blocker), and loop diuretic • In selected cases, digoxin, hydralazine, nitrates, or spironolactone may be added • Verapamil and diltiazem are contraindicated in treatment of SHF because they decrease ventricular contractility
Posted on: Fri, 04 Oct 2013 12:04:07 +0000
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