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  #1  
Old 10-11-2012
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Heart CHF Fat Guy

A 60-year-old man with a history of congestive heart failure (CHF) 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 for CHF 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/m≤. 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 patientís exertional fatigue?


1.decreased LV afterload
2.decreased RV afterload
3.HTN
4.Increased negative intrathoracic pressure
5.Pulmonary vasodilation
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  #2  
Old 10-11-2012
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wtf :S
The cause of his dyspnea is that this guy suffers from pulmonary edema secondary to his CHF :S
I seriously dont know what to pick.. prob chronic backflow of blood would in the long run cause Pulmonary hypertension...

Ill pick 3.. HTN just because he is a fat asshole lol or maybe 5 i really dont know
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  #3  
Old 10-11-2012
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this Qs is very confusing

If we think of obstructive sleep apnea ,then it should have pulmonary HTN and right heart hypertrophy.

the dude dont even have systolic murmur to think of aortic stenosis

I will go with HTN ,by eliminating other choices .HTN explains LVH and exertional dyspnea due to diastolic failure of heart .
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Old 10-11-2012
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Quote:
Originally Posted by step_enhancer View Post
this Qs is very confusing

If we think of obstructive sleep apnea ,then it should have pulmonary HTN and right heart hypertrophy.

the dude dont even have systolic murmur to think of aortic stenosis

I will go with HTN ,by eliminating other choices .HTN explains LVH and exertional dyspnea due to diastolic failure of heart .

Yeah we dont even know wtf, because 2 choices are high on the differential either OSA or CHF with paroxysmal nocturnal dyspnea.. and it sucks because the pathophys of both differs greatly...
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This one is a badass!
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  #6  
Old 10-11-2012
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ans 4 ........
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Quote:
Originally Posted by Hitman View Post
ans 4 ........
YOu mean because he is a a fat ass then he has changes in the intrathoracic pressure?
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  #8  
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obesity hypoventilation syndrome? so 4?
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Quote:
Originally Posted by XpaezX View Post
YOu mean because he is a a fat ass then he has changes in the intrathoracic pressure?
Pt has CHF and OSA so i guess

1 = he has increased afterload due to low CO so this appears wrong

2= decreased RV afterload is same as pulmonary vaso dilation ( although not mentioned weather arterial or venous ) OSA pt have Increased RV after load and pulmonary vasoconstriction due to hypoxia.

5 same as 2

3 HTN = pts with CHF usually have a low BP even though SVR is increased to maintain blood flow to organs but actual BP is low .

4 OSA pts have increase work of breathing so increases neg intra thoracic pressure to compensate as pt tries to breath with more effort to over come distension that increases venous return and worsens HF .
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OSA--->HTN--->Decompensation of his heart failure?
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  #11  
Old 10-20-2012
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4 Increased intrathoracic pressure!

Hitman, you got it, you are tha Man!!
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