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
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Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: mksap Tags: Conditions Heart Source Type: blogs
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