MKSAP: 81-year-old man after a percutaneous coronary intervention

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. An 81-year-old man is evaluated in the office 3 days following a percutaneous coronary intervention with placement of a bare metal stent in the left anterior descending artery for angina refractory to maximal medical therapy. He indicates that he feels well except for palpitations that were not present before the procedure. Medical history is significant for hypertension and type 2 diabetes mellitus. He has no risk factors for or history of significant bleeding. Medications are aspirin, clopidogrel, lisinopril, atorvastatin, and metformin. On physical examination, the patient is afebrile, blood pressure is 110/60 mm Hg, pulse rate is 65/min, and respiration rate is 12/min. BMI is 32. Estimated central venous pressure is not elevated. The heart has an irregularly irregular rhythm. Lungs are clear without crackles. An electrocardiogram shows atrial fibrillation with a heart rate of 65/min and no acute ischemic changes. An echocardiogram demonstrates a left ventricular ejection fraction of 30%. Which of the following is the most appropriate therapeutic regimen for this patient? A. Aspirin and clopidogrel B. Aspirin and dabigatran C. Aspirin and warfarin D. Aspirin, clopidogrel, and warfarin Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Heart Source Type: blogs