A 72-year-old female has a history of right heart failure caused by a right ventricular myocardial infarction. Which of the following symptoms are specifically related to her right heart failure?

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.

Choice A reason: Hereditary decrease in IgE responsiveness is not related to airway hyper-responsiveness in extrinsic asthma. IgE is an antibody that binds to allergens and triggers the release of histamine and other inflammatory mediators from mast cells. A decrease in IgE responsiveness would reduce the allergic reaction, not increase it.

Choice B reason: Increased sympathetic nervous system response is not related to airway hyper-responsiveness in extrinsic asthma. The sympathetic nervous system is the part of the autonomic nervous system that prepares the body for fight or flight. It stimulates the bronchodilation, or the widening of the airways, by activating the beta2 receptors on the smooth muscle cells. This would improve the airflow, not obstruct it.

Choice C reason: The release of stress hormones is not related to airway hyper-responsiveness in extrinsic asthma. Stress hormones, such as cortisol and adrenaline, are secreted by the adrenal glands in response to stress. They have anti-inflammatory and bronchodilator effects, which would reduce the symptoms of asthma, not worsen them.

Choice D reason: Exposure to an allergen causing mast cell degranulation is related to airway hyper-responsiveness in extrinsic asthma. Mast cell degranulation is the process of releasing histamine and other inflammatory mediators from the granules inside the mast cells. These substances cause bronchoconstriction, or the narrowing of the airways, by stimulating the smooth muscle contraction and mucus secretion. This leads to the symptoms of asthma, such as wheezing, coughing, and dyspnea.