Geriatric
Cardiology
Review
Kim Posey, DNP, AGPCNP-BC
CASE 1 (1 of 4)
A 70-year-old man comes to the office for follow-up
after hospitalization for exacerbation of HF.
History includes HF with preserved systolic function,
hypertension, and atrial fibrillation.
Longstanding medications include extended-release
metoprolol 100 mg/day, enalapril 10 mg q12h, and
hydrochlorothiazide 25 mg/day. In addition, he was
given both torsemide 40 mg q12h and digoxin 0.125
mg every other day during hospitalization and at
discharge.
1
, CASE 1 (2 of 4)
Today he reports new symptoms of fatigue and light-
headedness when he initially stands. He has no chest
pain, and there has been no change in SOB.
BP is 92/50 mmHg, pulse is 84 bpm, and O2
saturation is 97% on room air. Jugular venous
pressure is 5 cm2 HO; neck veins are flat, even when
he is supine. Chest is clear bilaterally. Heart sounds
are irregularly irregular with no murmur. The
abdomen is soft and nontender, with normal bowel
sounds and no distension. Extremities are mildly
cool; there is no edema, and dorsalis pedis pulses
are 1+ bilaterally.
CASE 1 (3 of 4)
Which of the following is the best next step?
A. Administer furosemide 80 mg by IV.
B. Discontinue enalapril and metoprolol.
C. Hold torsemide and hydrochlorothiazide
and prescribe fluids.
D. Obtain serum digoxin levels and
discontinue digoxin.
2
, CASE 1 (4 of 4)
Which of the following is the best next step?
A. Administer furosemide 80 mg by IV.
B. Discontinue enalapril and metoprolol.
C. Hold torsemide and hydrochlorothiazide
and prescribe fluids.
D. Obtain serum digoxin levels and
discontinue digoxin.
CASE 2 (1 of 4)
A 78-year-old woman is brought to the emergency
department because she has had shortness of breath
for 2 weeks; it has become more severe over the past
2 days.
She has difficulty sleeping and now requires 2 or 3
pillows to elevate her head at night.
History includes hypertension, osteoarthritis, and
COPD secondary to 50 pack-years of smoking.
Medications include amlodipine, hydrochlorothiazide,
and montelukast.
3
Cardiology
Review
Kim Posey, DNP, AGPCNP-BC
CASE 1 (1 of 4)
A 70-year-old man comes to the office for follow-up
after hospitalization for exacerbation of HF.
History includes HF with preserved systolic function,
hypertension, and atrial fibrillation.
Longstanding medications include extended-release
metoprolol 100 mg/day, enalapril 10 mg q12h, and
hydrochlorothiazide 25 mg/day. In addition, he was
given both torsemide 40 mg q12h and digoxin 0.125
mg every other day during hospitalization and at
discharge.
1
, CASE 1 (2 of 4)
Today he reports new symptoms of fatigue and light-
headedness when he initially stands. He has no chest
pain, and there has been no change in SOB.
BP is 92/50 mmHg, pulse is 84 bpm, and O2
saturation is 97% on room air. Jugular venous
pressure is 5 cm2 HO; neck veins are flat, even when
he is supine. Chest is clear bilaterally. Heart sounds
are irregularly irregular with no murmur. The
abdomen is soft and nontender, with normal bowel
sounds and no distension. Extremities are mildly
cool; there is no edema, and dorsalis pedis pulses
are 1+ bilaterally.
CASE 1 (3 of 4)
Which of the following is the best next step?
A. Administer furosemide 80 mg by IV.
B. Discontinue enalapril and metoprolol.
C. Hold torsemide and hydrochlorothiazide
and prescribe fluids.
D. Obtain serum digoxin levels and
discontinue digoxin.
2
, CASE 1 (4 of 4)
Which of the following is the best next step?
A. Administer furosemide 80 mg by IV.
B. Discontinue enalapril and metoprolol.
C. Hold torsemide and hydrochlorothiazide
and prescribe fluids.
D. Obtain serum digoxin levels and
discontinue digoxin.
CASE 2 (1 of 4)
A 78-year-old woman is brought to the emergency
department because she has had shortness of breath
for 2 weeks; it has become more severe over the past
2 days.
She has difficulty sleeping and now requires 2 or 3
pillows to elevate her head at night.
History includes hypertension, osteoarthritis, and
COPD secondary to 50 pack-years of smoking.
Medications include amlodipine, hydrochlorothiazide,
and montelukast.
3
