Question

You see a 92-year-old male with advanced dementia who also has Stage D heart failure. He is unable to perform ADL. He presents with lower limb edema and dyspnea at rest. He is currently taking a loop diuretic and ACE inhibitor. The most appropriate treatment option for this patient is:

a) Initiate treatment with inotropic agent.
b) Evaluation for pacemaker placement.
c) Left ventricular reconstruction surgery.
d) Consideration for compassionate end-of-life care.

Answer 1

The most appropriate treatment option for this patient with advanced dementia and stage D heart failure would be consideration for compassionate end-of-life care.

Step-by-step explanation:

The most appropriate treatment option for this 92-year-old male with advanced dementia and stage D heart failure, who is unable to perform ADL and presenting with lower limb edema and dyspnea at rest, would be consideration for compassionate end-of-life care (option d).

At this stage, the patient's dementia and heart failure are both advanced, and his inability to perform activities of daily living combined with the symptoms of lower limb edema and dyspnea at rest indicate a poor prognosis and limited functional improvement. In this case, palliative care with a focus on symptom management and quality of life would be the most appropriate approach.

Initiating treatment with an inotropic agent (option a), evaluating for pacemaker placement (option b), or considering left ventricular reconstruction surgery (option c) would not address the patient's overall condition and would not significantly improve his quality of life given his advanced age, dementia, and stage D heart failure.