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
Earn CME Credits with ACP
ACP offers internists many CME options for the completion of AMA PRA Category 1 CME Credits™. Attend live meetings, work online, or watch course recordings on your own schedule.
Explore our many CME credit options.
The Next-Generation Clinical Information Resource
DynaMed Plus is a collaboration between ACP and EBSCO Health. ACP members enjoy free access to this comprehensive tool that optimizes time to answer for busy clinicians, like you. Get started now!