A 16-year-old new patient presents to the free clinic. He briefly tells his story, “I’ve always had a heart condition since I was a kid. I had heart surgery and then developed what they called SVT or something like that. I used to take a lot of medication to keep my BP and heart adjusted. I think one was Dig or something like that, they said it was for my heart beating so fast. I don’t remember the other one. I started drinking a lot a couple of years ago and mom kicked me out of the house. I’m not drinking anymore. I quit last month while in the youth shelter. They sent me here to get checked over since I keep having a lot of chest pain now and can’t keep up with my chores at the shelter.” Old records are not available. Current findings include: BP 194/100 P124 R22 CXR: left ventricular enlargement with pulmonary engorgement. No ankle edema. Liver enlarged on palpation.
1. What might you expect/do regarding pharmacologic management of the SVT?
2. How would you manage the elevated BP in this pediatric patient?
3. What would you do regarding the chest pain?
4. Does this patient meet criteria for heart failure? If yes, what is the pharmacological management?