A 63-year-old female patient presents to the emergency department with symptoms of syncope and exertional chest discomfort. Her medical history is significant for scleroderma. An echocardiogram reveals right ventricular hypertrophy and increased pulmonary artery pressures. Which initial treatment strategy would be MOST appropriate for this patient with suspected pulmonary hypertension?
Start diuretic therapy and oxygen supplementation alone.
Initiate an endothelin receptor antagonist.
Begin treatment with a calcium channel blocker.
Prescribe empiric antibiotics while awaiting further studies.
Patients presenting with symptoms of pulmonary hypertension and a history of scleroderectomy are at risk for pulmonary arterial hypertension, which classically is associated with connective tissue diseases like scleroderma. While diuretics and oxygen could be used as supportive therapy, the initiation of endothelin receptor antagonists, such as bosentan, specifically targets pulmonary arterial hypertension by blocking endothelin, a substance that causes blood vessels to constrict. Calcium channel blockers are generally not the initial treatment of choice as they can be harmful in patients with pulmonary arterial hypertension unless they responded positively to a vasodilator challenge, which is not indicated in the information provided. Empiric antibiotics without evidence of infection would not address her pulmonary hypertension and syncope.
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