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USMLE
USMLE I Test Block II
A 68-year-old man with no previous medical problems presents to the clinic with shortness of breath and swelling of his ankles. Symptoms have progressed over the past few months. The patient has a regular heart rate and rhythm, an S4 is heard on cardiac auscultation, and inspiratory rales are heard throughout the lower half of the lung fields. Also, 2+ pitting edema is evident over the tibial surfaces. Echocardiography reveals an ejection fraction of 60%. Which of the following is most likely to improve this patient’s condition?
Explanation
ExplanationThe correct answer is D. Systemic hypertension and left ventricular hypertrophy is often one of the main etiologies of diastolic dysfunction and therapy centers around aggressive treatment including β-blockers. Lowering heart rate also allows more ventricular filling time. Tachycardia should be avoided in the setting of diastolic failure.
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