Valsartan+enalapril for CHF

[DarkProtoman]

Yes, I'm a lowly pre-med posting on the cardiology forum...I respect you awesome cardiologists, esp. you interventional cardiologists and electrophysiologists.

Here's my question: For the purposes of this question, I'm an categorical internal medicine resident. A 30yr patient is in moderate-to-severe CHF, w/ an ejection fraction of 33.333%, a stroke volume of 46.667ml, a cardiac output of 5600.04, and a pulse pressure of 27mmHg. I prescribe valsartan and enalapril, b/c recent research shows that combining a angiotensin II receptor antagonist w an ACE inhibitor is more effective then using either alone. The pharmacy doses it. Now, w/ his/her stats, would it be time to consult a cardiothoracic surgeon to install a LVAD, add digoxin to his medication regimen, or something else?

Thanks!!!

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[souljah1]

What?

 

[DarkProtoman]

What?

Um, I'm asking you guys to help me solve my imaginary clinical scenario. That shouldn't be too hard. Or is my scenario not realistic. Thanks.

 

[nattygann01]

What are you doing?

 

[DarkProtoman]

What are you doing?

I was researching heart failure in my old textboot --a general internal mdicine text my Dr friend gave me as a gift--, and I was wondering what the proper treatment of a heart failure w/ these specific stats would be? Should a positive inotope like oral dobutamine be added? Thanks!

 

[P Diddy]

Yes, I'm a lowly pre-med posting on the cardiology forum...I respect you awesome cardiologists, esp. you interventional cardiologists and electrophysiologists.

Here's my question: For the purposes of this question, I'm an categorical internal medicine resident. A 30yr patient is in moderate-to-severe CHF, w/ an ejection fraction of 33.333%, a stroke volume of 46.667ml, a cardiac output of 5600.04, and a pulse pressure of 27mmHg. I prescribe valsartan and enalapril, b/c recent research shows that combining a angiotensin II receptor antagonist w an ACE inhibitor is more effective then using either alone. The pharmacy doses it. Now, w/ his/her stats, would it be time to consult a cardiothoracic surgeon to install a LVAD, add digoxin to his medication regimen, or something else?

Thanks!!!

I have to say that though you are a complete troll, you really made me laugh. My favorite parts of your scenario are:

1. 'For the purposes of this question, I'm an (sic) categorical medicine resident'.

It does seem crucial to the nature of this question that you be a categorical medicine resident. For the purposes of my answer, could you be a sad clown, or an OB (there may not be an appreciable difference between the two)?

2. the pulse pressure is 27 mm Hg

so is the blood pressure 28/1, or 228/201?

on the off chance that you are just someone trying to get an internet forum to do your homework for you, please ask an intelligible, direct question. your scenario has too many holes in it for anyone to be helpful.

p diddy

 

[DarkProtoman]

I have to say that though you are a complete troll, you really made me laugh. My favorite parts of your scenario are:

1. 'For the purposes of this question, I'm an (sic) categorical medicine resident'.

It does seem crucial to the nature of this question that you be a categorical medicine resident. For the purposes of my answer, could you be a sad clown, or an OB (there may not be an appreciable difference between the two)?

2. the pulse pressure is 27 mm Hg

so is the blood pressure 28/1, or 228/201?

Patient has severe dyspnea on exertion --as in s/he couldn't climb the front door steps w/o gasping for air and taking his/her bronchodilator --s/he also has (formerly) well controlled asthma; s/he's been thinking her symptoms were related to that-- --, 5 pillow orthopnea, rapid resting heart rate on average of 120bpm, ejection fraction of 33.333%, stroke volume of 46.667ml, cardiac output of 5600.04ml/min, bp of 80/53, pp of 27mmHg, O2 saturation of 75%, BNP of 750pg/mL, left ventricular hypertrophy of 150%, periphial edema, cold sweats, severe vertigo, the list is endless. S/he's been hospitalized several times w/i the last six months w/ severe breathlessness and angina. His/her latest hospitalization is where my scenario comes in. --His/her GP must not be the sharpest drawer in the knife; he still thinks it's exercised-induced asthma--. S/he either has CHF or PPH, but a cardiac catherization I --in my scenario-- ordered ruled out the latter. I --in my infinitismal knowledge-- prescribe valsartan, enalapril, chlortalidone, furosemide, and carvedilol, and order a referral to a cardiothoracic surgeon to see about the possibility of adding a ventricular assist device.

Do we have enough info now? Thank you. I am sorry if I appeared as a troll.

 

[Cards09]

This kid's not even in college....

http://forums.studentdoctor.net/showpost.php?p=6506159&postcount=13

You can't really expect us to take you seriously; you can't learn medicine just from a book(s). You may think you know what you're talking about but you really don't. It's the blunt truth, sorry. If this is an attempt to impress us or to obtain self-validation you haven't succeeded.

Rather than posting ridiculous scenarios you should focus on getting into a good college and (if you do well enough) medical school.

And dude, get out and enjoy the California weather rather than reading medical books!

 

[Strength&Speed]

they seem awfully symptomatic for an ef of 33.333% Are you sure it isn't 31%?

 

[Strength&Speed]

hh

 

[Trifling Jester]

Please refer to the ACC guidelines on heart failure for the consensus recommendations regarding your questions:
http://www.acc.org/qualityandscience/clinical/guidelines/failure/indexupdate101705_pkt.pdf

Good luck,
The Trifling Jester