A 42-Year-Old Man Comes to the Emergency Department Due to Fatigue

question 117

Multiple Choice

A 42-year-old man comes to the emergency department due to fatigue, chest pain, and shortness of breath for the past 5 days.  He has had difficulty falling asleep at night due to chest discomfort.  The patient had a "bad case of the flu" 3 weeks ago and still has a persistent cough.  He is otherwise healthy and has no other medical problems.  He has a 20-pack-year smoking history and drinks 3 or 4 beers on weekends.
Blood pressure is 92/54 mm Hg and pulse is 112/min.  Blood pressure decreases to 75/42 mm Hg during inspiration.  Jugular venous pressure is estimated at 16 cm H₂O.  There are minimal crackles present at both lung bases.  Heart sounds are faint on cardiac auscultation.  Lower extremities are cool with feeble pulses.
Chest x-ray is shown in the exhibit.
An echocardiogram in this patient would most likely show which of the following?

• A)Dynamic left ventricular outflow obstruction
• B)Global left ventricular hypokinesis
• C)Left ventricular diastolic collapse
• D)Right atrial diastolic collapse
• E)Right ventricular dilation

---

Definitions:

Office Manager

A professional responsible for overseeing the daily operations of an office, including administrative, personnel, and logistical functions.

Filing Procedures

The protocols and steps required to properly submit legal documents and filings to a court or official registry.

Ordering Supplies

The process of procuring materials, equipment, or other items necessary for the operation of a business or other organization.

Support Personnel

Staff members who provide technical, administrative, or logistical support within an organization.