CHF secondary to mitral valve prolapse Patient was brought to the Emergency Room by her family because of difficulty breathing and palpitations.
Patient reports that she has experienced these symptoms for the past 6 months, but this episode is more
severe than any previous. Upon admission in the ER, heart rate was 120 beats per minute and blood pressure
was 180/110. The results of an EKG and cardiac enzyme blood tests were normal. She was admitted for a
complete workup for tachycardia and hypertension.
Patient underwent a full battery of diagnostic tests. A prolapsed mitral valve was observed by
echocardiography. A stress test had to be stopped early due to onset of severe difficulty in breathing,
Angiocardiography failed to demonstrate significant CAD. Blood pressure and tachycardia were con-
trolled with medications. At discharge, HR was 88 beats per minute and blood pressure was 165/98.
There was no evidence of a myocardial infarction or significant CAD. Patient was placed on a low-salt
and low-cholesterol diet. She received instructions on beginning a carefully graded exercise program.
She is to continue her medications. If symptoms are not controlled by these measures, a mitral valve
replacement will be considered,
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Why is it important that fibrin is insoluble in water?

Aperson who doesn't have enough calcium in his or her diet is at risk for developing bones that are weak and break easily. this condition is known as  a.  osteoporosis.    b.  crohn's disease.    c.  celiac disease.    d.  hemophilia.

The parents of a 9-year-old girl bring their daughter to the ed. for the last 12 hours, the child has suffered severe nausea and vomiting, as well as diarrhoea and abdominal cramps. further discussion with the child indicates that she suffers from blurred vision and headache. the parents originally were worried about bringing the child to the ed because they feared deportation since the family are illegal immigrants employed to pick strawberries on a nearby farm. on direct questionning, the parents admit that the child was assisting with spraying crops with pesticides the previous day. none of the family members was wearing any protecting clothing. her bp is 88/48 mmhg, pulse is 90/min, rr 33/min, temp 38 c. the child appears sweaty and confused. auscultation of the lungs reveals a diffuse wheeze bilaterally. pupils are miotic and the child has diffuse muscle weakness. which of the following interventions is the most appropriate treatment? - atropine- charcoal- glucagon- naloxone- exposure: consider organophosphate poisoning, which inhibits cholinesterase and results in accumulation of ach in both muscarinic and nicotinic sites. pralidoxime activates achatropine competes with ach only at muscarinic receptors, but will not reverse nicotinic effectscharcoal = gastric decontaminationglucagon = reverse beta-blocker overdosenaloxone = reverse effects of opioids