A 72-Year-Old Man Is Brought to the Emergency Department Due

question 24

Multiple Choice

A 72-year-old man is brought to the emergency department due to 3 days of worsening cough and shortness of breath.  The cough is productive of a small amount of white sputum.  The patient has no chest pain.  He has a history of hypertension, gout, chronic obstructive pulmonary disease, and coronary artery disease for which he underwent coronary artery bypass grafting.  He also had mitral valve repair 6 years ago.  The patient has a 40-pack-year smoking history and continues to smoke a pack of cigarettes a day.
Blood pressure is 136/72 mm Hg, pulse is 132/min, and respirations are 26/min.  Oxygen saturation is 92% on room air.  The patient appears to be in moderate respiratory distress.  Jugular venous pulse is difficult to measure due to use of accessory muscles.  Lung auscultation shows decreased air entry in both lung fields.  There is diffuse and scattered wheezing heard throughout the lung zones.  Heart sounds are irregular with a faint holosystolic murmur heard over the cardiac apex.  There is 1+ bilateral pitting ankle edema.
Laboratory results are as follows:
ECG is shown in the exhibit.
Which of the following is the best treatment for this patient's cardiac condition?

• A)Cardiac glycoside
• B)Corticosteroids and inhaled bronchodilators
• C)Electrical cardioversion
• D)Intravenous amiodarone
• E)Intravenous ibutilide

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