Heart failure Quiz: Ace Your Exams

A 66-year-old nonbinary individual presents to the emergency department for evaluation of shortness of breath with exertion. The patient reports increasing shortness of breath over the past several weeks to the point where they can no longer climb a flight of stairs without becoming winded. Past medical history includes hypertension, hyperlipidemia, and deep vein thrombosis following a knee replacement surgery ten years ago. The patient has not seen a physician in years and is currently not on any medications. They currently smoke one pack of cigarettes daily. Temperature is 36.1°C (97.0°F), pulse is 78/min, respirations are 22/min, blood pressure is 188/92 mmHg, and O2 saturation is 91% on room air. Physical examination demonstrates an additional heart sound heard just after S2, and diffuse rales on lung auscultation. Jugular venous distension, pitting edema, and hepatomegaly are absent. A chest X-ray is obtained and demonstrated below. Which of the following best describes the pathophysiology of this patient’s pulmonary findings?  


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