The MKSAP Challenge
A 58-year-old man with a history of congestive heart failure develops psoriatic arthritis. He has chronic stable exertional dyspnea but no chest pain or orthopnea. Medications are warfarin, aspirin, a statin, an angiotensin-converting enzyme inhibitor and a beta-blocker.
On physical examination, pulse rate is 66/min and irregular, respiration rate is 12/min, and blood pressure is 130/60 mm Hg. There is no jugular venous distention, and the lungs are clear to auscultation. An electrocardiogram reveals atrial fibrillation, a previous anterior myocardial infarction and an incomplete left bundle-branch block. An echocardiogram shows a left ventricular ejection fraction of 38%.
Which of the following is a contraindication for initiating infliximab therapy in this patient?
A. Atrial fibrillation
B. Cardiac conduction abnormality
C. Decreased ejection fraction
D. Ischemic heart disease
Internist Archives Quick Links
What will you learn from your Annals Virtual Patient?
Annals Virtual Patients is a unique patient care simulator that mirrors real patient care decisions and consequences. CME Credit and MOC Points are available. Start off with a FREE sample case. Start your journey now.
Internal Medicine Meeting 2015 Live Simulcast!
Unable to attend the meeting this year? On Saturday, May 2, seven sessions will be streamed live from the meeting. Register for the simulcast and earn CME credit after watching each session. Watch it live or download for later viewing.