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A 65-year-old woman notices shortness of breath with exertion while working long hours…

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A 65-year-old woman notices shortness of breath with exertion while working long hours in her bakery. She has a 20-year history of poorly controlled hypertension. The shortness of breath is accompanied by onset of swelling of the feet and ankles and increasing fatigue. On physical examination in the clinic, she is found to be mildly short of breath lying down but feels better sitting upright. Crackles (due to fluid accumulation) are noted at both lung bases, and her jugular venous pressure is elevated. There is 3+ edema of the ankles and feet. An echocardiogram shows an enlarged, poorly contracting heart with a left ventricular ejection fraction of about 30% (normal: 60%). The diagnosis is class III congestive heart failure (CHF).Questions:1. What drug should be administered immediately to reduce the edema in her ankles and feet?2. Where in the kidney does this drug act?3. What drugs are given to prevent the deleterious effects of catecholamines on the heart in patients with CHF?

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