Question

A 50-year-old man presents with sudden onset shortness of breath. He has a risk of heart failure with an ejection fraction of 25%. Vital signs include temperature 100º F, blood pressure 220/110 mm Hg, heart rate 125 beats/minute, and respiratory rate 30 breaths/minute. On examination, he appears anxious and tachypneic. Chest X-ray demonstrates diffuse bilateral interstitial opacification. What is the most appropriate initial treatment?

A) Albuterol
B) Dobutamine
C) Furosemide
D) Nitroglycerin

Answer 1

Furosemide is the most appropriate initial treatment for a patient presenting with clinical signs of acute decompensated heart failure and pulmonary edema.

Step-by-step explanation:

The most appropriate initial treatment for a 50-year-old man presenting with sudden onset shortness of breath, an ejection fraction of 25%, fever, and extremely high blood pressure, who is found to have diffuse bilateral interstitial opacification on a chest X-ray, is C) Furosemide. These clinical findings suggest acute decompensated heart failure with pulmonary edema.

The patient's symptoms of anxiety, tachypnea, and the signs on the chest X-ray of fluid in the interstitial space are indicators of this. Furosemide is a loop diuretic that will help reduce the fluid overload by increasing urine production and help relieve pulmonary congestion.

Other options like albuterol are more suitable for respiratory conditions like asthma, dobutamine is typically used for heart failure but not indicated in this scenario due to high blood pressure, and nitroglycerin is generally used for chest pain associated with angina, not primarily for heart failure-induced pulmonary edema.