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congestive heart failure
the patient: a 70-year-old man
reason for admission: shortness of breath, severe fatigue and weakness, abdominal distension, and swelling of ankles
history and physical examination: On admission, the patient revealed a history of "four-pillow orthopnea" and frequent bouts of "air hunger" during the night. He admitted to several episodes of angina pectoris over the last few weeks and a progressive shortness of breath with exertion for several years. On examination, the chief abnormalities were cyanosis, distension of the neck veins, rapid breathing (20 breaths/min), bilateral basal rales, an enlarged heart, slight tachycardia (110 beats/min), a diastolic gallop rhythm, enlarged liver, excess fluid in the abdomen, and edema at the ankles and lower tibias. His blood pressure was 115/80 mm Hg. The chest X-ray examination showed an enlarged heart and diffuse density (indicative of fluid) at both lung bases. An electrocardiogram showed normal sinus rhythm, prominent Q waves, and left axis deviation. Treatment included bed rest and administration of digitalis and a diuretic agent.
1. What pathophysiological mechanisms are responsible for the DISTENSION OF THE NECK VEINS, ENLARGEMENT OF THE LIVER, and DEPENDENT EDEMA? Neck vein distension from fluid buildup in the venous system.
2. Why is the pathophysiological explanation for this patient's SHORTNESS OF BREATH?
3. What abnormalities (if any) would you expect to find in this patient with respect to EJECTION FRACTION and RESIDUAL CARDIAC VOLUME?
4. What physiological mechanism is this patient using to MAINTAIN CARDIAC OUTPUT in the face of myocardial failure?