A 74-Year-Old Man Is Admitted to the Intensive Care Unit

question 432

Multiple Choice

A 74-year-old man is admitted to the intensive care unit due to progressive shortness of breath for the last several days.  He has a past medical history of coronary artery bypass grafting at age 50, mitral valve repair at age 64, ischemic cardiomyopathy with left ventricular ejection fraction of 20%, atrial fibrillation, type 2 diabetes mellitus, peripheral vascular disease, and stage III chronic kidney disease.  The patient has had several hospital admissions for decompensated congestive heart failure over the past 2 years.
His temperature is 37.2 C (99 F) , blood pressure is 90/60 mm Hg, pulse is 96/min, and respirations are 22/min.  The patient's pulse oximetry is 88% on room air.  He is in mild respiratory distress.  Jugular venous pressure is elevated at 15 cm H₂O.  Lung examination reveals decreased breath sounds at the bases with bibasilar crackles up to the middle of the chest.  Cardiac examination reveals irregular heart tones and a II/VI holosystolic murmur heard over the cardiac apex.  There is 3+ lower extremity edema up to the mid thighs.
ECG shows atrial fibrillation at a rate of 94/min and low-voltage QRS complexes in the precordial leads.  Chest x-ray reveals cardiomegaly and significant pulmonary vascular congestion in addition to small bilateral pleural effusions.
Which of the following best describes the benefits of milrinone infusion in this patient?

• A)Alleviating symptoms of dyspnea
• B)Decreasing frequency of hypotensive episodes
• C)Decreasing risk of arrhythmias
• D)Improving long-term mortality
• E)Reducing frequency of ischemic events

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