Which condition is a cause of an acquired murmur?

A. A 79-year-old lifetime smoker who is complaining of shortness of breath and pain on deep inspiration: Chronic obstructive pulmonary disease (COPD) is most commonly seen in individuals with a significant smoking history. Progressive shortness of breath is a hallmark symptom of COPD, resulting from chronic airway inflammation and airflow limitation. While pain on deep inspiration is not a classic COPD symptom, it could indicate pleuritic involvement or hyperinflation-related chest discomfort.

B. An 88-year-old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke: Acute shortness of breath and airway constriction in response to tobacco smoke suggests an asthma-like reaction rather than COPD. COPD symptoms tend to be persistent and progressive rather than episodic.

C. An 81-year-old smoker who has increased exercise intolerance, a fever, and increased white blood cells: Fever and increased white blood cells indicate an acute infection rather than chronic lung disease. While COPD exacerbations can cause worsening symptoms, an isolated fever and elevated white blood cells suggest pneumonia or another infectious process rather than COPD alone.

D. An 81-year-old male who has a productive cough and recurrent respiratory infections: A productive cough and recurrent respiratory infections are common in chronic bronchitis, a component of COPD. However, this presentation alone is not specific to COPD, as other conditions, such as bronchiectasis, can also cause these symptoms.

A. Jugular vein distention: Pulmonary hypertension increases right ventricular afterload, leading to right heart failure. As the right ventricle struggles to pump against elevated pulmonary pressures, blood backs up into the systemic circulation, causing jugular vein distention (JVD).

B. Peripheral edema: Right-sided heart failure due to pulmonary hypertension leads to venous congestion and fluid retention, resulting in peripheral edema. Swelling is commonly observed in the lower extremities due to increased venous hydrostatic pressure.

C. Ronchi bilaterally: Rhonchi are low-pitched breath sounds typically associated with airway obstruction due to secretions, commonly seen in conditions like chronic bronchitis or pneumonia. Pulmonary hypertension primarily affects the pulmonary vasculature rather than the airways, making rhonchi an unlikely manifestation.

D. Dyspnea on exertion: Pulmonary hypertension increases pressure in the pulmonary arteries, reducing oxygen exchange and causing exertional dyspnea. This symptom is often one of the earliest clinical manifestations as increased pulmonary vascular resistance impairs oxygen delivery.

E. Systemic blood pressure greater than 130/90 mm Hg: Pulmonary hypertension specifically affects the pulmonary circulation, not systemic arterial pressure. While pulmonary hypertension can eventually contribute to left heart dysfunction, it does not directly cause systemic hypertension.