A 60-Year-Old Woman Is Brought to the Emergency Department After

question 25

Multiple Choice

A 60-year-old woman is brought to the emergency department after an episode of syncope.  She also has generalized weakness and mild nausea.  The patient was recently hospitalized for acute decompensated heart failure, and her left ventricular ejection fraction was estimated at 35% by echocardiography.  Her discharge medications include furosemide, carvedilol, lisinopril, aspirin, and atorvastatin.  At her outpatient visit a week ago, her lisinopril dose was increased and she was started on spironolactone.
Her temperature is 36.8 C (98.2 F) , blood pressure is 120/82 mm Hg, pulse is 74/min, and respirations are 16/min.  Pulse oximetry is 95% on room air.  Jugular venous pressure is 8 cm H₂O.  Scattered bibasilar crackles are present.  The patient has a grade 2/6 systolic ejection murmur along the right sternal border without radiation.  She has 1+ pedal edema to the knees bilaterally.
Her ECG shows no P waves and a wide complex regular rhythm at 74/min.  ECG done a week ago showed normal sinus rhythm, narrow QRS complexes (90 msec) , and non-specific T wave abnormalities.
The patient would most likely benefit from which of the following?

• A)Amiodarone
• B)Atropine
• C)Calcium gluconate
• D)Furosemide
• E)Metoprolol

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