A 42-year-old man comes to the physician because of a 1-year history of progressive fatigue and shortness of breath on exertion. He also finds it difficult to sleep lying flat and requires 3 pillows to prop himself upright when sleeping. He has smoked one pack of cigarettes daily for 30 years and drinks three to four cans of beer daily. He appears fatigued. Pulse is 94/min, respirations are 23/min, and blood pressure is 150/60 mm Hg. 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?

Question

A 42-year-old man comes to the physician because of a 1-year history of progressive fatigue and shortness of breath on exertion. He also finds it difficult to sleep lying flat and requires 3 pillows to prop himself upright when sleeping. He has smoked one pack of cigarettes daily for 30 years and drinks three to four cans of beer daily. He appears fatigued. Pulse is 94/min, respirations are 23/min, and blood pressure is 150/60 mm Hg. 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?

Quizplus · Accepted Answer

Eductional Objective: Left-sided heart failure can cause secondary pulmonary hypertension via elevated left-sided diastolic filling pressures transmitting backward to the pulmonary veins, resulting in pulmonary venous congestion.  Over time, pulmonary arterial remodeling (medial hypertrophy and intimal thickening with fibrosis) can occur, but not to the extent that occurs in (primary) pulmonary arterial hypertension.

A 42-Year-Old Man Comes to the Physician Because of a 1-Year