Ace the Case: A 53-Year-Old Woman with Shortness of Breath on Exertion
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Correct answer: A.
Rationale: Ms. R now has high-risk PAH. All patients with high-risk PAH should be treated with an intravenous prostanoid, such as epoprostenol.1,8 Inhaled iloprost can be used as a second-line treatment in those who cannot tolerate intravenous medication.1,8 Bosentan would not be helpful. She is already taking an endothelin receptor antagonist. Hospice should not be considered next as the patient is otherwise healthy with additional treatment options.