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?
- A)Atrial natriuretic peptide release
- B)Nitric oxide signaling
- C)Calcitonin secretion
- D)Parasympathetic nervous system
- E)Renin angiotensin aldosterone systemGABARITO
Explicação
Renin angiotensin aldosterone system is correct. Reduced forward flow in systolic heart failure activates RAAS, which increases afterload, sodium retention, fibrosis, and adverse ventricular remodeling. This is why ACE inhibitors, ARBs, and mineralocorticoid a... Ver explicação completa e trilha adaptativa →