Chief Complaint: 74-year-old woman with shortness of breath andswelling. History: Martha Wilmington, a 74-year-old woman with ahistory of rheumatic fever while in her twenties, presented to herphysician with complaints of increasing shortness of breath(\"dyspnea\") upon exertion. She also noted that the typical swellingshe's had in her ankles for years has started to get worse over thepast two months, making it especially difficult to get her shoes ontoward the end of the day. In the past week, she's had a decreasedappetite, some nausea and vomiting, and tenderness in the rightupper quadrant of the abdomen. On physical examination, Martha'sjugular veins were noticeably distended. Auscultation of the heartrevealed a low-pitched, rumbling systolic murmur, heard best overthe left upper sternal border. In addition, she had an extra, \"S3\"heart sound. Top of Form

5. You examine Martha's abdomen and find that she has anenlarged liver (\"hepatomegaly\") and a moderate degree of ascites(water in the peritoneal cavity). Explain these findings. 6.Examination of her ankles reveals significant \"pitting edema.\"Explain this finding. 7. She is advised to wear support stockings.Why would this help her? 8. Which term more accurately describesthe stress placed upon Martha's heart -- increased pre-load orincreased afterload? 9. What is the general term describingMartha's condition? 10. How might Martha's body compensate for theabove condition? 11. Martha is started on a medication calleddigoxin. Why was she given this medication, and how does it work?12. Two weeks after starting digoxin, Martha returns to thephysician's office for a follow-up visit. On physical examination,she still has significant hepatomegaly and pitting edema, and issignificantly hypertensive (i.e. she has high blood pressure). Herphysician prescribes a diuretic called furosemide (or \"Lasix\"). Whywas she given this