MCQ 15: Congestive heart failure (18)

Q. Which of the following drug may be stopped in asymptomatic patients with low left ventricular ejection fraction?

A. Beta blocker

B. ACE inhibitor

C. Diuretic

D. All of them should be stopped unless patient is symptomatic

Answer: C. Diuretic

Explanation:
Beta blockers and ACE inhibitors are used in CHF because they have suvival benefit. Both of these are class I recommendation in patients with heart failure with reduced ejection fraction (HFrEF). Whereas, Diuretics are used only for symptomatic benefit. So, if the patient is asymptomatic but having low ejection fraction, beta blockers and ACE inhibitors should be continued and diuretics are given according to symtoms of the patient.

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ECG Spotter

What is the diagnosis? Click the button below to view answer: Show Answer

High heart rate

The patient contacts the doctor over phone with this report. Obviously anxious because of his high heart rate (199 beats per minute) as detected by ECG machine. Should he be worried about this and come to emergency department as soon as possible? Correct answer- ECG machine has calculated his heart rate incorrectly. Heart rate is around 100 beats per minute. Other findings in this ECG include ST segment elevation in anterior chest leads along with presence of Q waves, denoting old MI changes with possibly development of LV aneurysm. In such cases, ST segment elevation can persist for long periods. Now, should he come to emergency department? Not because of detection of high heart rate. But, if he is having symptoms such as shortness of breath or chest pain, he should visit emergency department. Otherwise, if he is asymptomatic, he can schedule a regular visit with his cardiologist.

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