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He complains of some chest discomfort and tells you he has a familial heart problem and was told he should not run. BP is 100/80, respiratory rate (RR) is 20 breaths per minute, and pulse oximetry is 93 percent. The ECG shows sinus tachycardia at 115 beats per minute with septal Q and upright T waves. In addition to oxygen administration, which of the following is the MOST important therapeutic intervention? (A) Aspirin and nitroglycerin (B) Intravenous fluids and 5 mg intravenous labetalol (C) Nitroglycerin and a lidocaine drip (D) CPAP, nitroglycerin, and furosemide (E) Aspirin, nitroglycerin, and dopamine 74.

Splenomegaly is seen in 25 percent of patients. Almost all patients have a murmur at some point during the disease. Subacute endocarditis is predominantly left sided. 87. The answer is D. (Chapter 49) The Framingham heart study reported a 50 percent mortality in 5 years for CHF patients, with half the population dying within the first year. ACE inhibitors have been shown to slow the progression of disease and improve function in CHF patients, but they have not decreased the frequency of sudden death.

Sodium nitroprusside can be used, but the infusion should be brief and thiocyanate levels must be monitored. Labetalol is another second-line agent in this setting. Diuretics are contraindicated because the patient with PIH is already volume-contracted. Angiotensin-converting enzyme (ACE) inhibitors should not be used because they cross the placenta and may depress angiotensin II levels in the fetus. The definitive treatment of PIH is delivery of the baby. 54. The answer is E. (Chapter 53) Sodium nitroprusside, a rapidly acting arteriolar and venous dilator, is useful for treating hypertensive emergencies.

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Anatomia funzionale del sistema nervoso dell'uomo by John Nolte

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