Cardiology>>>>>Peripheral Vascular Disease
Question 9#

A 49-year-old man presents to the clinic with complaints of progressive exertional dyspnea for several weeks. His speech is mildly breathless. Neck veins are distended bilaterally and there is moderate lower extremity edema. He denies chest pain. Electrocardiogram (ECG) shows sinus tachycardia without ST-segment abnormality. Physical examination reveals a parasternal heave and systolic ejection murmur. Past medical history is significant for splenectomy after a car accident several years ago.

Which of the following will most accurately confirm the underlying cause of this patient’s symptoms? 

A. Chest computed tomography (CT) with IV contrast
B. Transthoracic echocardiogram
C. Transesophageal echocardiogram
D. Pulmonary arteriogram
E. Ventilation–perfusion scan

Correct Answer is D

Comment:

Pulmonary arteriogram. An arteriogram is the test most likely to confirm pulmonary artery hypertension in this patient presenting with cor pulmonale, although a right heart catheterization is usually done first. This patient most likely has chronic thromboembolic pulmonary hypertension (CTEPH), a condition seen in otherwise healthy postsplenectomy patients. Other predisposing conditions include history of pulmonary embolism, myeloproliferative disorders, and chronic inflammatory conditions.

Reference:

Hoeper MM, Mayer E, Simonneau G, et al. Chronic thromboembolic pulmonary hypertension. Circulation. 2006;113:2011–2020.