An 89-year-old man presents to the ED with 2 13 - highsky

[ArchivalUser]

An 89-year-old man presents to the ED with 2
days of painful lower extremity swelling and
shortness of breath. His blood pressure is
176/88 mm Hg with significant peripheral
edema, elevated jugular venous pulsations,
and rales on pulmonary examination. Laboratory
values are:
Na+ 34 mEq/L
K+ 5.3 mEq/L
Cl− 101 mEq/L
Blood urea nitrogen 54 mg/dL
Creatinine 1.7 mg/dL
Glucose 189 mg/dL
WBC count 6400/mm3
Hematocrit 37%
Platelet count 226,000/mm3
Troponin I 0.09 ng/dL
Creatine kinase, 6 ng/mL
myocardial bound
The physician suggests x-ray of the chest and
echocardiography to investigate further. The
patient™s ejection fraction is 70%. Which of the
following features is most consistent with the
diagnosis of diastolic dysfunction?
(A) Decreased end-diastolic pressure
(B) Decreased end-diastolic volume
© Decreased ejection fraction
(D) Decreased ratio of ventricular wall thickness
to ventricular cavity size
(E) Normal exercise capacity
(F) Normal x-ray of the chest

[ArchivalUser]

bb

[ArchivalUser]

I think it is DD

[ArchivalUser]

13. The correct answer is B. Diastolic heart failure
refers to the clinical evidence of heart failure
(dyspnea and increased venous pressure)
in the setting of a normal ejection fraction and
normal valvular function. Diastolic failure is
due to the inability of the ventricle to relax and
properly fill during diastole. This results in a
normal or decreased end-diastolic volume.
Answer A is incorrect. Elevated end-diastolic
pressure can be found in both systolic and diastolic
dysfunction.
Answer C is incorrect. Because contractile
strength is usually maintained in the setting of
a reduced end-diastolic volume, the ejection
fraction can actually be elevated in diastolic
heart failure.
Answer D is incorrect. One of the hallmarks
of diastolic dysfunction is a large, stiff ventricle
with an increased, not decreased, ratio of wall
thickness to cavity size. This can be the result
of hypertrophy or infiltrative disease.
Answer E is incorrect. Both systolic and diastolic
dysfunction are associated with similar
clinical symptoms, including a reduced exercise
capacity.
Answer F is incorrect. Both systolic and diastolic
dysfunction are associated with the typical
findings of pulmonary venous congestion
on x-ray of the chest, including cephalization
of pulmonary vessels.
14. The correct answer is D.

[ArchivalUser]

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