CHF Case Study

Shortness of breath in the middle of the night is specifically associated with which of the following
1) Increase in left atrial pressure
2) Increase in pulmonary capillary wedge pressure
3) Paroxysmal nocturnal dyspnea
4) Increase in right atrial pressure

1, 2, & 3

She also noted that the typical swelling she's had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In the past week, she's had a decreased appetite, some nausea and vomiting, and tenderness in the right upper quadrant of the abdomen.

Which are associated with the patient’s condition?
1) Decreased right atrial pressure
2) Hepatojugular reflux
3) Decreased right ventricular pressure
4) Jugular venous distention

2 & 4

Upon physical exam of this patient which of the following findings are more likely
a) normal split of the first heart sound
b) normal split of the second heart sound
c) wide split of the second heart sound
d) reverse split of the second heart sound
e) none of the above is possible

d) reverse split of the second heart sound

A chest X-ray reveals pulmonary edema, pleural effusion and cardiomegaly. EKG shows no acute ST&T changes and no Q wave. You examine Martha's abdomen and find that she has an enlarged liver ("hepatomegaly") and a moderate degree of ascites (water in the peritoneal cavity). Examination of her ankles reveals significant "pitting edema." Additional findings will include which of the following:
a) decrease in central venous pressure
b) increase in central venous pressure
c) systemic venous resistance is decreased
d) normal cardiac output
e) decreased left ventricular volume

b) increase in central venous pressure

Possible diagnosis of this patient includes

a) left ventricular failure with normal functioning right ventricle
b) right ventricular failure with normal functioning left ventricle
c) biventricular congestive heart failure
d) myocardial infarction
e) prinzmetal angina

c) biventricular congestive heart failure