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Old 02-16-2012
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Lungs Cause of dyspnea

A 60-year-old man with a history of congestive heart failure presents to his physician with an 8-month history of exertional fatigue and excessive daytime sleepiness. His wife has told him that he has episodes of choking in his sleep. He has been taking enalapril, metoprolol, and hydrochlorothiazide and is compliant. He denies chest pain, palpitations, or swelling in his legs. He is afebrile and vital signs are normal. His oxygen saturation is 99% on room air and
his body mass index is 30.2 kg/mē. On cardiac examination his apical impulse is diffuse and shifted 2 cm to the left of the midclavicular line. Heart sounds are normal. Jugular venous distention and peripheral edema are absent. X-ray of the chest shows no active disease and ECG is significant for left ventricular hypertrophy. Which of the following is the most likely cause of the patient’s exertional fatigue?

(A) Decreased left ventricular afterload
(B) Decreased right ventricular afterload
(C) Hypertension
(D) Increased negative intrathoracic pressure
(E) Pulmonary vasodilation

is it OSA or chf ? very confusing...please help
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Old 02-16-2012
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Since patient have exertional dysnea since 8 months...he have OSA but seems recent onset and but chf is since many days and i think it is primary condition for causing dysnea....

so i think its C.

What is the ans?
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Old 02-16-2012
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the pt is suffering from obstructive sleep apnea leading to pulmonary hypertension n right heart failure
so should the ans be D
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Old 02-16-2012
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i think it is obstructive sleep apnea. because although it is congestive heart patient he is controlled by drugs. ecg finding is probably the cause which lead to ccf.
OAS not CCF would explain the cause of excessive daytime sleepliness.
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Old 02-16-2012
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yes, its OSA. but why ECG shows LVH [ points towards chf] and apical impulse is down and out [ points towards systolic failure].

ans is D. because in OSA, there is more negative intra-thoracic pressure.
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Quote:
Originally Posted by tyagee View Post
yes, its OSA. but why ECG shows LVH [ points towards chf] and apical impulse is down and out [ points towards systolic failure].

ans is D. because in OSA, there is more negative intra-thoracic pressure.
ECG finding is due to LV hypertrophy probably the cause which lead to CHF.

why would there be negative intrathoracic pressure in OSA?

yes i no other response is better unless of pulmonary vasodilatation it would have been vasoconstriction. it would have been a better response.
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Old 02-17-2012
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ans is D. because in OSA, there is more negative intra-thoracic pressure.[/QUOTE]

why NEgative intrathoracic pressure?
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Old 02-18-2012
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Quote:
Originally Posted by pass7 View Post
ans is D. because in OSA, there is more negative intra-thoracic pressure.

why NEgative intrathoracic pressure?
any cause of dyspnea makes intrathoracic pressure more negative in an effort to breathe [ inhale ]...this is what i think.

explanation from the answer does not mention clearly but says...
.. During each obstructive ap-
neic event, negative intrathoracic pressure in-
creases, thereby increasing LV afterload and ad-
versely affecting LV function....
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