A 66-year-old female presents with fatigue, shortness of breath with exertion, cough, and swelling of the ankles. Current medications include lipid-lowering medication for hyperlipidemia and beta blocker for hypertension
On physical examination, vital signs are 98 degrees, 18 resps/min, pulse 56, and BP 100/60. Heart demonstrates S3 gallop and S4. Lungs reveal bilateral basilar crackles. Abdomen is distended with shifting dullness and hepatomegaly. Extremities show bilateral ankle edema. No neurological deficits. These signs and symptoms are characteristic of:
A. Chronic renal failure
B. Congestive heart failure
C. Metabolic syndrome
D. Liver failure
ANS: B
CHF, commonly occurring in the elderly or in patients with past myocardial infarctions or cardiomyopathy, can often present with complaints of fatigue, decreased activity tolerance, and/or shortness of breath. A patient with a history of hypertension and hyperlipidemia indicates cardiovascular disease that predisposes to heart failure with age. The signs of heart failure include cough, shortness of breath with exertion, S3 and S4 heart sounds, pulmonary crackles, ascites, hepatomegaly and ankle edema.
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