Question

A 69-year-old man with a 50-pack/year smoking history, COPD for 12 years, and a myocardial infarction 2 years ago has been experiencing increased exertional dyspnea for 4 months. There is associated easy fatigability, exertional chest discomfort, and lightheadedness. He denied fever, chills, palpitations, cough, wheezing, abdominal pain, nausea, vomiting, and diarrhea. Physical exam findings were remarkable for a right ventricular heave, widely split S2 with an accentuated pulmonic component, a pulmonary ejection click, an S3 and 1+ pitting edema to the bilateral lower extremities. There was also evidence of a 5 cm jugular vein distention.

What diagnostic test results would be expected in this patient?

1. Underdevelopment of central pulmonary arteries and hyperemic lung field on chest X-ray
2. Right axis deviation, R wave greater than S wave in V1, and peaked p-waves on EKG
3. A normal FEV1 to FVC ratio on pulmonary function testing
4. Increased thickness of the left atrium on echocardiography
5. Pulmonary arterial pressure of 15 mm Hg on pulmonary artery catherization

Answer 1

Given the symptoms and medical history of the patient, one would anticipate diagnostic test results indicative of pulmonary hypertension and right-sided heart strain, such as right axis deviation, an R wave greater than the S wave in V1, and peaked P-waves on an EKG.

Step-by-step explanation:

The clinical scenario describes a 69-year-old man with a significant smoking history, chronic obstructive pulmonary disease (COPD), and a history of myocardial infarction presenting with symptoms suggestive of right-sided heart failure (cor pulmonale). Given the patient's physical exam findings including a right ventricular heave, widely split S2 with an accentuated pulmonic component, an S3, and peripheral edema, coupled with the history provided, one would expect certain diagnostic test results that align with the condition of pulmonary hypertension secondary to COPD.

Right axis deviation, an R wave greater than the S wave in V1, and peaked P-waves on the EKG are changes that are consistent with right ventricular hypertrophy and atrial enlargement, which can be seen in pulmonary hypertension or right-sided heart strain.

A normal FEV1 to FVC ratio on pulmonary function testing would not be expected in a patient with COPD, as they typically have a reduced ratio due to obstructive lung disease.

An increased thickness of the left atrium on echocardiography would not be as relevant in this case, as it is not indicative of the right-sided heart changes seen in COPD-related cor pulmonale.

Finally, a pulmonary arterial pressure of 15 mm Hg on pulmonary artery catheterization would be considered normal. However, in cor pulmonale secondary to COPD, one would expect the pulmonary arterial pressure to be elevated above the normal range (typically >25 mm Hg at rest).