A 25-year-old woman comes to the emergency department complaining of increasing dyspnea and orthopne

Discussion in 'Step 3' started by samuel, Dec 13, 2014.

  1. samuel

    samuel New Member

    A 25-year-old woman comes to the emergency department complaining of increasing dyspnea and orthopnea over the past 10 days. She is in the thirty-second week of pregnancy and reports several episodes of paroxysmal nocturnal dyspnea for the last 4 nights. On arrival at the hospital she is given 60 mg of intravenous furosemide. However she does not improve upon diuresis. The family informs you that she has a history of rheumatic heart disease and rheumatic mitral stenosis. Her last echocardiogram revealed a mitral valve area of 1 cm2. Medications include digoxin 0.5 mg daily. On examination, her blood pressure is 95/85 mm Hg and pulse is 115/min. The jugular venous distention is at 15 cm of water. Lung examination reveals bilateral crackles. Her heart is irregular. Which of the following is the most appropriate management at this time?
    A. Urgent direct-current cardioversion
    B. Urgent induction of vaginal delivery
    C. Urgent cesarean section
    D. Percutaneous balloon valvotomy of the mitral valve
    E. Treatment with lisinopril

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