What type of angina is characterized by vasospasms of coronary arteries and causes unpredictable chest pain?

A. A 79-year-old lifetime smoker who is complaining of shortness of breath and pain on deep inspiration: Chronic obstructive pulmonary disease (COPD) is most commonly seen in individuals with a significant smoking history. Progressive shortness of breath is a hallmark symptom of COPD, resulting from chronic airway inflammation and airflow limitation. While pain on deep inspiration is not a classic COPD symptom, it could indicate pleuritic involvement or hyperinflation-related chest discomfort.

B. An 88-year-old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke: Acute shortness of breath and airway constriction in response to tobacco smoke suggests an asthma-like reaction rather than COPD. COPD symptoms tend to be persistent and progressive rather than episodic.

C. An 81-year-old smoker who has increased exercise intolerance, a fever, and increased white blood cells: Fever and increased white blood cells indicate an acute infection rather than chronic lung disease. While COPD exacerbations can cause worsening symptoms, an isolated fever and elevated white blood cells suggest pneumonia or another infectious process rather than COPD alone.

D. An 81-year-old male who has a productive cough and recurrent respiratory infections: A productive cough and recurrent respiratory infections are common in chronic bronchitis, a component of COPD. However, this presentation alone is not specific to COPD, as other conditions, such as bronchiectasis, can also cause these symptoms.

A. Deep vein thrombosis: Patients with deep vein thrombosis (DVT) are at a significantly higher risk for developing pulmonary embolism (PE) due to the potential for thrombus formation in the veins to dislodge and travel to the lungs. Assessing this patient as a priority is crucial, as timely intervention can prevent the development of PE.

B. Endocarditis: While endocarditis can lead to embolic events, it typically results in systemic emboli rather than specifically causing pulmonary embolism. The immediate priority for PE assessment is lower in patients with endocarditis compared to those with DVT.

C. Left heart failure: Left heart failure can lead to pulmonary congestion and respiratory symptoms but does not directly indicate a high risk of pulmonary embolism. While it is important to monitor these patients, assessing for PE is not the immediate priority.

D. Valvular disease: Valvular disease can increase the risk of thrombus formation, particularly if it results in atrial fibrillation. However, the direct connection to pulmonary embolism is not as pronounced as in patients with DVT. Therefore, assessing patients with valvular disease for PE is not the priority compared to those with DVT.