Lymphology Association of North America (LANA) Practice Exam

Which pathophysiological processes can cause edema in patients with congestive heart failure (CHF)?

1. Increased colloid osmotic pressure

2. Hypoproteinemia with lymphatic decompensation

3. Increased capillary filtration with lymphatic decompensation

4. Decreased capillary reabsorption

The correct answer is: Increased capillary filtration with lymphatic decompensation

The correct answer highlights the relationship between increased capillary filtration and lymphatic decompensation as significant mechanisms contributing to edema in patients with congestive heart failure (CHF). In CHF, the heart's reduced ability to pump effectively leads to increased pressure within the vascular system, particularly in the capillaries. This elevated pressure promotes the movement of fluid from the vascular space into the interstitial tissue, resulting in edema. As the body's ability to manage this excess fluid is compromised, lymphatic decompensation can occur. The lymphatic system typically helps to return excess interstitial fluid to circulation; however, when it is overwhelmed or functioning inadequately, the result is an accumulation of fluid in tissues. In summary, the combination of heightened capillary filtration due to increased vascular pressure and the failure of the lymphatic system to cope with the excess fluid creates a significant pathway for edema development in CHF patients. This process underscores the importance of both hemodynamics and lymphatic function in the presence of heart failure.