Which condition is described by fluid in the lungs due to left ventricular failure, with orthopnea and blood-tinged sputum?

• A. Pulmonary edema
• B. Pulmonary embolism
• C. Chronic obstructive pulmonary disease
• D. Spontaneous pneumothorax

Answer: (A)

Fluid in the lungs from left-sided heart failure is pulmonary edema. When the left ventricle can’t pump effectively, blood backs up into the left atrium and then into the pulmonary veins, raising pressure in the lung capillaries. This pushes fluid out into the lung tissue and air spaces, making it harder for oxygen to move into the blood and causing shortness of breath.

Orthopnea, or difficulty breathing when lying flat, happens because lying down increases return of blood to the heart, raising pulmonary pressures and worsening edema. Blood-tinged, frothy sputum can occur when the capillaries leak fluid and small amounts of blood mix with the edema fluid in the airways.

This pattern fits pulmonary edema rather than a pulmonary embolism, COPD, or a spontaneous pneumothorax. A pulmonary embolism typically presents with sudden chest pain and shortness of breath without the orthopnea pattern or pink-tinged sputum; COPD involves chronic, not acute, dyspnea and productive cough; a spontaneous pneumothorax presents with sudden unilateral chest pain and absent breath sounds, not the edema-focused symptoms described.