The patient feels better after receiving appropriate therapy. A more detailed physical examination shows the presence of thoracolumbar scoliosis. Serial cardiac enzymes are negative. Arterial blood gas analysis shows respiratory alkalosis. Complete blood cell count and serum chemistry results are unremarkable. The patient is scheduled for echocardiography. Which of the following is the most likely diagnosis?
- A. Coronary artery disease r
- B. Ehlers-Danlos syndrome r
- C. Marfan syndrome r
- D. Rheumatic fever r
- E. Thyrotoxicosis
A 72-year-old Caucasian man comes to the physician’s office because of palpitations. He has had these symptoms for the past few hours. He also complains of dyspnea on exertion and malaise for the past few months. His other medical problems include hypertension and degenerative joint disease. He has smoked one pack of cigarettes daily for 55 years. His medications include hydrochlorothiazide and fosinopril. His blood pressure is 140/90 mm Hg, pulse is 148/min, and respirations are 20/min. Physical examination reveals scattered rhonchi and wheezes in both lungs. The heart sounds and the rest of the examination are normal. The electrocardiogram (EKG) demonstrates tachycardia with narrow QRS complexes, different P wave morphologies, and variable PR segments and R-R intervals. A diagnosis of multifocal atrial tachycardia is made.
Which of the following is the most appropriate next step in management?
- A. Administer an intravenous bolus of digoxin r
- B. Obtain a chest x-ray r
- C. Administer intravenous amiodarone r
- D. Check the arterial oxygen saturation r
- E. Administer an intravenous dose of atenolol