An investigator is studying patients with acute decompensated congestive heart failure. He takes measurements of a hormone released from atrial myocytes, as well as serial measurements of left atrial and left ventricular pressures. The investigator observes a positive correlation between left atrial pressures and the serum level of this hormone. Which of the following is most likely the mechanism of action of this hormone?
AIncreases potassium excretion at the collecting ducts
BConstricts afferent renal arteriole
CDecreases sodium reabsorption at the collecting tubules
DDecreases reabsorption of bicarbonate in the proximal convoluted tubules
EIncreases free water reabsorption from the distal tubules
The serum brain natriuretic peptide and N-terminal pro-BNP are elevated. A diagnosis of heart failure with preserved ejection fraction is made. In addition to supplemental oxygen therapy, which of the following is the most appropriate initial step in management?
AIntravenous dobutamine
BIntravenous furosemide therapy
CIntravenous morphine therapy
DThoracentesis
EIntermittent hemodialysis
A 54-year-old man is brought to the emergency department 1 hour after the sudden onset of shortness of breath, epigastric pain, and sweating. He has no history of similar symptoms. He has hypertension and type 2 diabetes mellitus. Current medications include amlodipine and metformin. He has smoked one pack of cigarettes daily for 20 years. He appears weak and pale. His pulse is 56/min, respirations are 18/min, and blood pressure is 100/70 mm Hg. Cardiac examination shows normal heart sounds. The lungs are clear to auscultation. The skin is cold to the touch. An ECG is shown. Bedside transthoracic echocardiography shows normal left ventricular function. High-dose aspirin is administered. Administration of which of the following is most appropriate next step in management?
AIntravenous atropine
BIntravenous morphine
CNormal saline bolus
DPhenylephrine infusion
ESublingual nitroglycerin
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