A 60-year-old man presents with progressive dyspnea, orthopnea, and bilateral fine basal crackles. Echocardiography shows left ventricular ejection fraction of 30% with global hypokinesia. Pulmonary function testing reveals FEV1 65% predicted, FVC 62% predicted, and FEV1/FVC ratio of 0.85. What pattern of ventilatory defect is seen?

• A Obstructive pattern
• B Normal spirometry
• C Mixed obstructive-restrictive pattern
• D Restrictive pattern ✓

Explanation

The patient has congestive cardiac failure causing pulmonary edema with interstitial fluid reducing lung compliance. Spirometry shows proportionally reduced FEV1 and FVC with preserved FEV1/FVC ratio (>0.7), which defines a restrictive pattern. In obstruction, the ratio would be reduced. In mixed pattern, both FEV1/FVC would be low and lung volumes would show hyperinflation. This distinguishes cardiac restriction from obstructive lung disease.

Reference: West's Respiratory Physiology, 10th ed.

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