Kardiologischer Fall: 62-jähriger Mann mit Dyspnoe und peripheren Ödemen von Joseph Alpert, MD

A 62-year-old man is admitted to the hospital because of marked shortness of breath and peripheral edema. The patient is a heavy smoker, and he has had pneumonia numerous times over many years. On physical examination, he appears thin, his respiratory rate is 20 beats/min, his blood pressure is 162/90 mm Hg, his heart rate is 92 beats/min, and his oxygen saturation 84% on room air but 91% on 4 liters of oxygen by nasal cannula. His jugular venous pulse is at 14 cm of water. On auscultation, distant lung sounds with poor ventilatory capacity and distant, hard-to-hear heart sounds are noted. On palpation, the liver is felt to be enlarged, with its margin 4 cm below the right costal margin. 3–4 peripheral edema extending to the thigh is noted. An ECG and chest x-ray are performed. Which of the following will most likely be found on ECG?

A 62-year-old man is admitted to the hospital because of marked shortness of breath and peripheral edema. The patient is a heavy smoker, and he has had pneumonia numerous times over many years. On physical examination, he appears thin, his respiratory rate is 20 beats/min, his blood pressure is 162/90 mm Hg, his heart rate is 92 beats/min, and his oxygen saturation 84% on room air but 91% on 4 liters of oxygen delivery by nasal cannula. His jugular venous pulse is at 14 cm of water. On auscultation, distant lung sounds with poor ventilatory capacity and distant, hard-to-hear heart sounds are noted. On palpation, the liver is felt to be enlarged, with its margin 4 cm below the right costal margin. 3–4 peripheral edema extending to the thigh is noted. An ECG shows right ventricular hypertrophy, and a chest x-ray indicates hyperinflated lungs with multiple areas of atelectasis or scarring. Which of the following is the most likely diagnosis?

A 62-year-old man is admitted to the hospital because of marked shortness of breath and peripheral edema. The patient is a heavy smoker, and he has had pneumonia numerous times over many years. On physical examination, he appears thin, his respiratory rate is 20 beats/min, his blood pressure is 162/90 mm Hg, his heart rate is 92 beats/min, and his oxygen saturation 84% on room air but 91% on 4 liters of oxygen delivery by nasal cannula. His jugular venous pulse is at 14 cm of water. On auscultation, distant lung sounds with poor ventilatory capacity and distant, hard-to-hear heart sounds are noted. On palpation, the liver is felt to be enlarged, with its margin 4 cm below the right costal margin. 3–4 peripheral edema extending to the thigh is noted. An ECG shows right ventricular hypertrophy, and a chest x-ray indicates hyperinflated lungs with multiple areas of atelectasis or scarring. After an echocardiogram, the diagnosis of cor pulmonale is established. Which of the following will most likely be seen on an echocardiogram?