A 65-year-old woman with chronic obstructive pulmonary disease comes to the office for a follow-up appointment. The patient reports increasing shortness of breath that is not relieved by her inhalers. Her other medical conditions include osteoarthritis. She is a former smoker with a 45-pack-year history. Blood pressure is 120/70 mm Hg, pulse is 75/min, and respirations are 22/min. Oxygen saturation on room air is 91% at rest. On physical examination, jugular venous pressure is elevated. There is increased intensity of the pulmonic component of S2. Breath sounds are decreased bilaterally with scattered wheezes but no crackles. There is 2+ lower extremity edema. Which of the following hemodynamic parameters is most likely to be increased in this patient?

Question

Quizplus · Accepted Answer

Eductional Objective: Advanced hypoxic lung disease (eg, chronic obstructive pulmonary disease, interstitial lung disease, obesity hypoventilation syndrome) is a common cause of pulmonary hypertension (ie, increased right ventricular afterload).  The increase in pulmonary arterial pressure mainly results from chronic and diffuse hypoxic vasoconstriction, with a lesser degree of vascular remodeling than in (primary) pulmonary arterial hypertension.

A 65-Year-Old Woman with Chronic Obstructive Pulmonary Disease Comes to the Office