A 60-year-old male presents to his primary care provider reporting chest pain. He is diagnosed with atherosclerosis. This disease results in:

Choice A reason: Use of accessory breathing muscles is a sign of respiratory distress and increased work of breathing. Accessory muscles are the muscles of the neck, chest, and abdomen that assist the diaphragm and intercostal muscles in breathing. They are normally not used for breathing, but they are recruited when the airway is obstructed or the lung function is impaired.

Choice B reason: Foul-smelling sputum is not a sign of an acute asthma episode. It is a sign of a bacterial infection or a lung abscess. Sputum is the mucus that is coughed up from the lungs. It can have different colors, textures, and odors depending on the cause and severity of the condition.

Choice C reason: Feeling of chest tightness is a sign of an acute asthma episode. It is caused by the bronchoconstriction, or the narrowing of the airways, that occurs during an asthma attack. It can also be accompanied by pain or pressure in the chest.

Choice D reason: Coughing is a sign of an acute asthma episode. It is a reflex action that tries to clear the airways of mucus, irritants, or foreign particles. It can also be triggered by the inflammation and hypersensitivity of the airways that occur during an asthma attack.

Choice E reason: Expiratory wheezing is a sign of an acute asthma episode. It is a high-pitched whistling sound that is heard when the person exhales. It is caused by the turbulent flow of air through the narrowed airways. It can also be heard on inspiration, but it is more prominent on expiration.

Choice A reason: Vasodilators are not the preferred agents for the initial treatment of heart failure. They are used as adjunctive therapy to reduce the afterload and preload on the heart. However, they do not address the fluid overload that is the main cause of heart failure symptoms.

Choice B reason: Diuretics are the preferred agents for the initial treatment of heart failure. They help to reduce the fluid overload and congestion in the lungs and peripheral tissues. They also lower the blood pressure and improve the cardiac output and renal function.

Choice C reason: Calcium channel blockers are not the preferred agents for the initial treatment of heart failure. They are contraindicated in most cases of heart failure because they can worsen the cardiac function and increase the mortality. They can also cause peripheral edema and hypotension.

Choice D reason: Direct renin inhibitors are not the preferred agents for the initial treatment of heart failure. They are a newer class of drugs that block the renin-angiotensin-aldosterone system (RAAS), which is involved in the pathophysiology of heart failure. However, they have not shown any significant benefit over the existing RAAS inhibitors, such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). They can also cause hyperkalemia and renal impairment.