Cardiology from the Grand Round

(A) Which of the following, affect plasma level of Digoxin :-1/ St John's wort 2/ Gaviscon 3/ Sulfasalazine 4/ Amiodarone (B) 60 year old man comes to see you with shortness of breath. You take a careful and detailed history, perform a clinical examination, and suspect heart failure. He has never had a previous myocardial infarction. His serum natruritic peptide came back very high ( BNP 610 pg/ml ), what should you do next ?1/ Make a routine referral to a cardiologist 2/ Refer urgently, to have transthoracic Doppler 2D echocardiography and specialist assessment within two weeks 3/ Check his ECG, CXR, Blood Urea and Electrolytes 4/ Start him on ACE inhibitor and B-Blocker5/ Start him on ARB and nitrates(C) A 78 year old man complains of shortness of breath and ankle swelling. On examination he has a slow rising pulse and an ejection systolic murmur radiating into his neck. You also find clinical evidence of heart failure. What should you do? 1/ Refer for Specialist Assessment2/ Start an ACE inhibitor3/ Star  an ARB
Source: Doc2Doc BMJ Cardiology - Category: Cardiology Authors: Source Type: forums