American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following is a symptom indicative of pulmonary hypertension in heart failure patients?

1. Syncope during exercise

2. Exertional dyspnea

3. Leg swelling

4. Fatigue at rest

The correct answer is: Exertional dyspnea

Exertional dyspnea is a key symptom indicative of pulmonary hypertension, particularly in patients with heart failure. In the context of pulmonary hypertension, as the right ventricle faces increased pressure due to compromised pulmonary circulation, patients often experience difficulty breathing during physical exertion. This is primarily due to the impaired ability of the lungs to deliver sufficient oxygen to the blood and the challenges the heart faces in pumping against elevated pressures. As the condition progresses, the demand for oxygen increases with exercise, leading to a symptom of dyspnea, which can significantly impact the patient's quality of life. This symptom contrasts with other common manifestations of heart failure, which may arise from fluid overload rather than pulmonary arterial pressure increases. For instance, while syncope, leg swelling, and fatigue can be associated with heart failure, exertional dyspnea specifically points to the effects of pulmonary hypertension on respiratory capacity during activities.