A 65-Year-Old Man with Nonischemic Cardiomyopathy Treated with Furosemide, Carvedilol

A 65-year-old man with nonischemic cardiomyopathy treated with furosemide, carvedilol, lisinopril, and digoxin comes to the emergency department with palpitations.  His last left ventricular ejection fraction was 35%.  His blood pressure is 160/100 mm Hg and pulse is 130/min and irregular.  Lungs are clear to auscultation.  The abdomen is soft and nondistended.  ECG shows atrial fibrillation with rapid ventricular response and nonspecific T-wave changes.  Therapy with rivaroxaban and amiodarone is initiated with improvement in symptoms.  The patient is discharged home after 2 days, with these new medications added to his initial regimen.  Two weeks later, he returns to the emergency department with profound anorexia, nausea, and generalized weakness.  Which of the following is the most likely cause of this patient's symptoms?

A) Drug interaction
B) Erosive gastritis
C) Gastrointestinal bleeding
D) Mesenteric ischemia
E) Occult carcinoma
F) Pancreatitis

Correct Answer:

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