Heart Failure USMLE Step 1 Practice Question
A 63-year-old man with ischemic cardiomyopathy presents with progressive exertional dyspnea and orthopnea. Vital signs show BP 118/76 mmHg, HR 102 bpm, RR 22/min, and SpO2 88% on room air. Echocardiography demonstrates ejection fraction of 28% with dilated left ventricle. B-type natriuretic peptide is elevated at 850 pg/mL. He denies peripheral edema. He takes aspirin and a beta-blocker but not an ACE inhibitor. Activation of which neurohormonal system most directly contributes to maladaptive ventricular remodeling?
Answer choices
- AAtrial natriuretic peptide release
- BNitric oxide signaling
- CCalcitonin secretion
- DParasympathetic nervous system
- ERenin angiotensin aldosterone systemCorrect answer
- FSympathetic nervous system activation
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