Posted by new from IP 66.212.131.19 on January 27, 2007 at 19:32:53:
A 71-year-old woman is hospitalized with an acute inferior wall myocardial infarction. On physical examination, her heart rate is 100/min, respiration rate is 18/min, and blood pressure is 171/88 mm Hg. The heart sounds are regular, with normal S1 and S2, an S4, and a grade 1/6 aortic outflow murmur at the left upper sternal border. The remainder of the physical examination is unremarkable.
Electrocardiography shows sinus rhythm and inferior ST-segment elevation. After the administration of aspirin, heparin, metoprolol, and nitroglycerin, cardiac catheterization shows a mid-right coronary artery occlusion, which is treated with angioplasty and stent placement. The remaining coronary arteries are normal.
She does well until the second hospital day when she develops acute dyspnea. On physical examination her heart rate is 131/min, respiration rate is 40/min, and blood pressure is 88/58 mm Hg. There are pulmonary crackles, a hyperdynamic precordium, a summation gallop, and a short, early-systolic murmur.
Which of the following is the best course of emergency action for this patient?
( A ) Right heart catheterization
( B ) Bedside cardioversion
( C ) Bedside echocardiography
( D ) Coronary arteriography