A 38-year-old woman comes to the physician because of a 4-month history of worsening fatigue. She has had occasional exertional chest pain and shortness of breath over the past year but has not seen a physician. She takes no medications. Her temperature is 37°C (98.6°F), pulse is 94/min, respirations are 24/min, and blood pressure is 130/84 mm Hg. Lung auscultation is normal. An echocardiogram shows an enlarged coronary sinus. Which of the following is the most likely cause of the observed finding in this patient?

Question

A 38-year-old woman comes to the physician because of a 4-month history of worsening fatigue. She has had occasional exertional chest pain and shortness of breath over the past year but has not seen a physician. She takes no medications. Her temperature is 37°C (98.6°F), pulse is 94/min, respirations are 24/min, and blood pressure is 130/84 mm Hg. Lung auscultation is normal.  An echocardiogram shows an enlarged coronary sinus.  Which of the following is the most likely cause of the observed finding in this patient?

Quizplus · Accepted Answer

Eductional Objective: The coronary sinus communicates freely with the right atrium and will become dilated secondary to any factor that causes increased right atrial pressure. The most common cause is pulmonary hypertension, leading to elevated right heart pressures.

A 38-Year-Old Woman Comes to the Physician Because of a 4-Month