A 56-Year-Old Man Comes to the Emergency Department Due to Progressively

question 236

Multiple Choice

A 56-year-old man comes to the emergency department due to progressively worsening dyspnea.  The patient can walk only a few blocks before becoming short of breath.  He also finds it difficult to sleep lying flat and requires 3 pillows to prop himself upright when sleeping.  Other medical problems include long-standing hypertension, for which he occasionally takes his prescribed antihypertensive medication.  The patient does not use tobacco, alcohol, or illicit drugs.  Blood pressure is 170/100 mm Hg, and pulse is 80/min and regular.  Physical examination reveals bilateral basilar lung crackles, jugular venous distension, and bilateral lower extremity edema.  Chest x-ray reveals cardiomegaly and hilar prominence.  ECG shows left ventricular hypertrophy.  Echocardiogram shows elevated pressures in the pulmonary artery.  Which of the following is the most likely underlying cause of the observed echocardiographic finding in this patient?

• A)Hypoxia-induced pulmonary vasoconstriction
• B)Increased pulmonary arterial blood flow
• C)Increased pulmonary venous pressure
• D)Inflammatory pulmonary vascular disease
• E)Obliteration of the pulmonary vascular bed
• F)Thrombotic obstruction of the pulmonary arterial tree

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