Heart Failure USMLE Step 1 Practice Question
A 76-year-old woman with a 20-year history of hypertension presents with progressive exertional dyspnea and orthopnea for 3 months. She takes lisinopril but remains non-adherent. Vital signs: BP 168/92 mm Hg, HR 88/min, RR 22/min, SpO2 98% on room air. Cardiac examination reveals an S4 gallop. Echocardiography demonstrates concentric left ventricular hypertrophy with ejection fraction of 55%. There is no peripheral edema. Which underlying pathophysiologic abnormality best explains her clinical presentation?
Answer choices
- AVolume overload from chronic mitral regurgitation
- BReduced ventricular compliance causing impaired fillingCorrect answer
- CMyocyte loss from transmural infarction
- DFibrofatty replacement of the right ventricle
- EDestruction of the interventricular septum
- FSystolic dysfunction from dilated cardiomyopathy
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