A 72-year-old man presents to the emergency department complaining of severe shortness of breath. He

A 72-year-old man presents to the emergency department
complaining of severe shortness of breath. He has long-standing poorly
controlled hypertension and a history of coronary artery disease and two
myocardial infarctions. About 1 week before admission, he had an episode of
substernal chest pain lasting approximately 30 minutes. Since then he has noted
progressive shortness of breath to the point that he is now dyspneic on minimal
exertion such as walking across the room. He notes a new onset of shortness of
breath while lying down. He is only comfortable when propped up by three
pillows.
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A 72-year-old man presents to the emergency department
complaining of severe shortness of breath. He has long-standing poorly
controlled hypertension and a history of coronary artery disease and two
myocardial infarctions. About 1 week before admission, he had an episode of
substernal chest pain lasting approximately 30 minutes. Since then he has noted
progressive shortness of breath to the point that he is now dyspneic on minimal
exertion such as walking across the room. He notes a new onset of shortness of
breath while lying down. He is only comfortable when propped up by three
pillows. He is occasionally awakened from sleep acutely short of breath. On
examination he is afebrile, with a blood pressure of 160/100 mm Hg, heart rate
of 108/min, respiratory rate of 22/min, and oxygen saturation of 88% on room
air. He is pale, cool, and diaphoretic. Jugular venous pressure is 10 cm H2O.
Chest auscultation reveals rales in both lungs to the mid-lung fields. Cardiac
examination reveals tachycardia, with an audible S3 and S4 . No murmurs or rubs
are heard. Extremities are without edema. The ECG shows left ventricular
hypertrophy and Q waves in the anterior and lateral leads, consistent with this
patient’s history of hypertension and myocardial infarction. Chest x-ray film
reveals bilateral fluffy infiltrates consistent with pulmonary edema. He is
admitted to the ICU with a diagnosis of heart failure and possible myocardial
infarction.

Questions

A. What are the four factors that account for almost all
cases of pulmonary edema? Which are probably responsible for this patient’s
pulmonary edema?

B. How does poor cardiac function cause pulmonary edema?

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