Adult Critical Care Specialty (ACCS) Practice Exam

Which diagnosis should be considered for a patient with abdominal pain and signs of right heart failure?

1. Pulmonary hypertension

2. Congestive heart failure

3. Hypovolemic shock

4. Aortic dissection

The correct answer is: Pulmonary hypertension

When evaluating a patient who presents with abdominal pain and signs of right heart failure, pulmonary hypertension emerges as a key diagnosis to consider. In this condition, the right ventricle has an increased workload due to elevated pressures in the pulmonary arteries, which can lead to right-sided heart failure. This type of heart failure may manifest with symptoms such as peripheral edema, jugular venous distention, and hepatic congestion—all of which can contribute to abdominal pain as the liver becomes engorged. Pulmonary hypertension can be caused by various factors, including chronic lung disease, left heart disease, or pulmonary vascular disease, and its recognition is crucial, particularly when the patient exhibits signs of right heart strain. Abdominal pain might occur as a consequence of venous congestion in the portal circulation due to the increased right heart pressure. While other conditions like congestive heart failure, hypovolemic shock, and aortic dissection may also present with certain aspects of heart failure or abdominal symptoms, they don't specifically align with the constellation of right heart failure symptoms in the context of pulmonary vascular resistance as prominently as pulmonary hypertension does. Therefore, it’s essential to prioritize pulmonary hypertension in this clinical scenario.