A 60-year-old man comes to the office for follow up appointment, he feels shortenss of breath while walking his dog around the block. He states that he is experiencing a dyspnea while sleeping therefor he uses 3 pillows or sleep on the recliner. The patient had an acute myocardial infarction 2 years ago and has been nonadherent with his medications. Temperature is 36.9 C (98 F), blood pressure is 125/74 mm Hg, pulse is 92/min, and respirations are 21/min. Physical examination shows bibasilar lung crackles, jugular venous distension, and bilateral pitting edema in the lower extremities. Chest x-ray reveals cardiomegaly and pulmonary venous congestion. Which of the following factors is most likely contributing to this patient's symptoms?

Question

A 60-year-old man comes to the office for follow up appointment, he feels shortenss of breath while walking his dog around the block. He states that he is experiencing a dyspnea while sleeping therefor he uses 3 pillows or sleep on the recliner.   The patient had an acute myocardial infarction 2 years ago and has been nonadherent with his medications.  Temperature is 36.9 C (98 F), blood pressure is 125/74 mm Hg, pulse is 92/min, and respirations are 21/min.  Physical examination shows bibasilar lung crackles, jugular venous distension, and bilateral pitting edema in the lower extremities.  Chest x-ray reveals cardiomegaly and pulmonary venous congestion.  Which of the following factors is most likely contributing to this patient's symptoms?

Quizplus · Accepted Answer

Eductional Objective: In the heart failure patient with reduced cardiac output, the sympathetic nervous system and renin-angiotensin-aldosterone pathway are activated which leads to vasoconstriction and increase afterload. Preload will be increased due to fluid retention. these mechanism leads to symptomatic decompensate heart failure

A 60-Year-Old Man Comes to the Office for Follow Up