MKSAP: 55-year-old man with nonischemic cardiomyopathy

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated during a routine examination. He has a 2-year history of nonischemic cardiomyopathy. (Echocardiogram 2 years ago demonstrated a left ventricular ejection fraction of 35%.) He is feeling well and reports no shortness of breath; he walks 2 miles daily without symptoms. Medical history is remarkable for hypertension. Medications are lisinopril, carvedilol, and chlorthalidone. On physical examination, blood pressure is 150/90 mm Hg and pulse rate is 50/min. No jugular venous distention is present. Cardiac examination reveals a regular rhythm with no murmurs or gallops. Lungs are clear to auscultation. No edema is present. Laboratory studies show serum creatinine level of 1.5 mg/dL (133 µmol/L), sodium level of 138 mEq/L (138 mmol/L), and potassium level of 4.0 mEq/L (4.0 mmol/L). Electrocardiogram shows a normal sinus rhythm and left ventricular hypertrophy. Which of the following calcium-channel blockers should be added to this patient’s medical regimen? A: Amlodipine B: Diltiazem C: Nifedipine D: Verapamil 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