Cardiac Medicine Certification (CMC) Practice Exam

What finding on chest X-ray might suggest heart failure?

1. Pleural effusion and pulmonary edema

2. Bronchial obstruction and consolidation

3. Normal lung fields

4. Enlarged cardiac silhouette only

The correct answer is: Pleural effusion and pulmonary edema

The finding of pleural effusion and pulmonary edema on chest X-ray is indicative of heart failure because these conditions are consequences of increased hydrostatic pressure in the pulmonary circulation due to impaired heart function. In heart failure, the heart is unable to pump efficiently, leading to fluid accumulation in the lungs (pulmonary edema) and potential fluid in the pleural cavities (pleural effusion). When assessing the X-ray, the presence of bilateral pleural effusions can suggest elevated pressures in the heart and lungs. Similarly, pulmonary edema, which presents as bilateral fluffy opacities or "bat-wing" patterns in the lung fields, indicates fluid accumulation in the alveoli, commonly associated with left-sided heart failure. These findings are essential components of the evaluation for heart failure and emphasize the gravity of the condition. In contrast, bronchial obstruction and consolidation, as well as normal lung fields, do not specifically point to heart failure. An enlarged cardiac silhouette could indicate heart failure as well, but by itself, it may not be definitive without accompanying signs of fluid overload, making the combination of pleural effusion and pulmonary edema a more comprehensive indicator.