A 49-year-old man presents to his physician complaining of weakness and fatigue. On exam, you note significant peripheral edema. Transthoracic echocardiogram is performed and reveals a preserved ejection fraction with impaired diastolic relaxation. A representative still image is shown in Image A. Which of the following is likely the cause of this patient's symptoms?
AHemochromatosis
BHeavy, long-term alcohol consumption
CHistory of myocardial infarction
DHistory of a recent viral infection
EPrevious treatment with doxorubicin
A 76-year-old woman seeks evaluation at a medical office for chest pain and shortness of breath on exertion of 3 months' duration. Physical examination shows bilateral pitting edema on the legs. On auscultation, diffuse crackles are heard over the lower lung fields. Cardiac examination shows jugular venous distention and an S3 gallop. Troponin is undetectable. A chest film shows cardiomegaly and pulmonary edema. Which of the following medications would be effective in lowering her risk of mortality?
APropranolol
BDigoxin
CLisinopril
DFurosemide
EVerapamil
A 64-year-old man presents to his physician for a scheduled follow-up visit. He has chronic left-sided heart failure with systolic dysfunction. His current regular medications include captopril and digoxin, which were started after his last episode of symptomatic heart failure approximately 3 months ago. His last episode of heart failure was accompanied by atrial fibrillation, which followed an alcohol binge over a weekend. Since then he stopped drinking. He reports that he has no current symptoms at rest and is able to perform regular physical exercise without limitation. On physical examination, mild bipedal edema is noted. The physician suggested to him that he should discontinue digoxin and continue captopril and scheduled him for the next follow-up visit. Which of the following statements best justifies the suggestion made by the physician?
ALong-term digoxin therapy produces significant survival benefits in patients with heart failure, but at the cost of increased heart failure-related admissions.
BBoth captopril and digoxin are likely to improve the long-term survival of the patient with heart failure, but digoxin has more severe side effects.
CCaptopril is likely to improve the long-term survival of the patient with heart failure, unlike digoxin.
DDigoxin does not benefit patients with left-sided heart failure in the absence of atrial fibrillation.
EDigoxin is useful to treat atrial fibrillation, but does not benefit patients with systolic dysfunction who are in sinus rhythm.
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