Advanced Patient Assessment Practice Exam

What finding would suggest the presence of congestive heart failure (CHF) in a patient?

1. Low diaphragm

2. Increased retrosternal air space

3. Increased cardiothoracic ratio

4. Tracheal deviation

The correct answer is: Increased cardiothoracic ratio

The presence of congestive heart failure (CHF) can lead to changes in the shape and size of the heart as observed on imaging studies. An increased cardiothoracic ratio is indicative of an enlarged heart relative to the thoracic cavity. In cases of CHF, the heart often enlarges due to volume overload, leading to a higher cardiothoracic ratio. This measurement is calculated by dividing the greatest horizontal heart diameter by the greatest internal thoracic diameter. When this ratio exceeds normal values, it signals possible cardiac enlargement, which aligns with the pathophysiology of CHF. In contrast, other options do not specifically indicate the presence of CHF. A low diaphragm may be seen in other conditions, such as chronic obstructive pulmonary disease (COPD), while an increased retrosternal air space can suggest conditions such as pneumothorax or mediastinal shift, which are unrelated to CHF. Tracheal deviation may indicate various mediastinal pathologies or tension pneumothorax but does not provide direct information about the state of heart failure. Thus, the increased cardiothoracic ratio stands out as a direct indicator of potential congestive heart failure.