Heart failure Quiz: Ace Your Exams

 76-year-old woman presents to the emergency department for evaluation of increased lower extremity swelling and shortness of breath. The patient has had progressive lower extremity swelling over the past several weeks to the point where she can no longer fit into her normal shoe size. In addition, she can no longer walk half a city block before becoming short of breath. Past medical history includes hypertension, diabetes, and a deep vein thrombosis after a long flight ten years ago. The patient has been smoking one pack of cigarettes per day for thirty-five years. Temperature is 36.1°C (97.0°F), pulse is 78/min, respirations are 16/min, blood pressure is 156/92 mmHg, and O2 is 90% on room air. Physical examination demonstrates a loud P2, jugular venous distension, faint bilateral end-expiratory wheezing, and 2+ pitting edema in the bilateral lower extremities. A chest X-ray is obtained and shown below. Which of the following best describes the pathophysiology of this patient’s lower extremity findings?  


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