American Board of Internal Medicine (ABIM) Certification Practice Exam

For patients with pulmonary hypertension related to left-sided heart disease, treatment is primarily directed at which aspect?

1. Managing pulmonary vascular resistance

2. Addressing symptoms of right heart failure

3. Evaluating pulmonary function

4. Treating the underlying cardiac disease

The correct answer is: Treating the underlying cardiac disease

In patients with pulmonary hypertension due to left-sided heart disease, the primary focus of treatment is directed at addressing the underlying cardiac condition. This is because the elevated pulmonary pressures in these patients are secondary to the dysfunction of the left side of the heart, such as left ventricular failure or valvular heart disease. By targeting the root cause of the condition—namely, improving the function of the left heart or correcting any structural issues—there is potential to reduce the resultant pulmonary hypertension. Managing pulmonary vascular resistance, while important, is more relevant in cases of primary pulmonary hypertension or those not directly linked to left heart disease. Similarly, although addressing symptoms of right heart failure is a necessary component of comprehensive care for these patients, it does not tackle the underlying cause of the pulmonary hypertension. Evaluating pulmonary function is also crucial for understanding the patient's overall health and guiding treatment, but it is not the main treatment focus in this context. Therefore, directing treatment efforts towards the underlying cardiac disease is essential for improving both cardiac output and pulmonary pressures.