A 68-year-old woman has had increasing dyspnea and orthopnea for the past year. She does not...

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A 68-year-old woman has had increasing dyspnea and orthopnea for the past year. She does not report any chestpain. On physical examination, her temperature is 36.9°C, pulse is 77/min, respirations are 20/min, and blood pressure is 140/90 mm Hg. On auscultation of the chest, diffuse crackles are heard in all lung fields. No murmurs or gallops are heard, and the heart rate is regular. A chest radiograph shows prominent borders on the left and right sides of the heart. Coronary angiography shows 60% proximal occlusion of the right coronary and circumflex arteries, and 50% occlusion over the first 3 cm of the left anterior descending artery. Echocardiography shows no valvular abnormalities, but there is decreased left ventricular wall motion and an ejection fraction of 33% Laboratory studies show serum glucose of 81 mg/dL, creatinine of 1.6 mg/dL, total cholesterol of 326 mg/dL, triglyceride of 169 mg/dL, and troponin I of 1 ng/mL. Which of the following pharmacologic agents is most likely to be beneficial in the treatment of this patient? (A) Amiodarone □(B) Glyburide (C) Nitroglycerin □ (D) Propranolol (E) Simvastatin □ (F) Alteplase A 68-year-old woman has had increasing dyspnea and orthopnea for the past year. She does not report any chestpain. On physical examination, her temperature is 36.9°C, pulse is 77/min, respirations are 20/min, and blood pressure is 140/90 mm Hg. On auscultation of the chest, diffuse crackles are heard in all lung fields. No murmurs or gallops are heard, and the heart rate is regular. A chest radiograph shows prominent borders on the left and right sides of the heart. Coronary angiography shows 60% proximal occlusion of the right coronary and circumflex arteries, and 50% occlusion over the first 3 cm of the left anterior descending artery. Echocardiography shows no valvular abnormalities, but there is decreased left ventricular wall motion and an ejection fraction of 33% Laboratory studies show serum glucose of 81 mg/dL, creatinine of 1.6 mg/dL, total cholesterol of 326 mg/dL, triglyceride of 169 mg/dL, and troponin I of 1 ng/mL. Which of the following pharmacologic agents is most likely to be beneficial in the treatment of this patient? (A) Amiodarone □(B) Glyburide (C) Nitroglycerin □ (D) Propranolol (E) Simvastatin □ (F) Alteplase

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