Right heart failure (cor pulmonale) Quiz: Ace Your Exams
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A 56-year-old woman presents to her primary care physician for evaluation of worsening shortness of breath for the past two months. She reports an increase in lower extremity swelling, abdominal fullness, and early satiety. The patient recalls an episode of chest pressure and discomfort approximately three months ago for which she did not seek treatment. Past medical history includes hypertension, diabetes, and hyperlipidemia; and she has been intermittently compliant with amlodipine, metformin, and atorvastatin. Temperature is 37°C (98.6°F), pulse is 86/min, respirations are 16/min, blood pressure is 156/74 mmHg, and oxygen saturation is 97% on room air. The patient is in no acute distress and is resting comfortably on the examination table. Cardiopulmonary examination reveals a right-sided S3. She has notable jugular venous distention, 2+ pitting edema in the lower extremities bilaterally, and abdominal distention with a positive fluid wave. The lungs are clear to auscultation bilaterally. An electrocardiogram reveals normal sinus rhythm with Q-waves in the inferior leads. An echocardiogram is ordered and reveals impaired right ventricular (RV) wall motion and a reduced RV ejection fraction. Which of the following is the most likely cause of this patient's clinical findings?
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