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?
- A)Volume overload from chronic mitral regurgitation
- B)Reduced ventricular compliance causing impaired fillingGABARITO
- C)Myocyte loss from transmural infarction
- D)Fibrofatty replacement of the right ventricle
- E)Destruction of the interventricular septum
Explicação
Reduced ventricular compliance causing impaired filling is correct. Longstanding hypertension causes concentric hypertrophy and diastolic dysfunction, producing heart failure with preserved ejection fraction. The S4 and preserved ejection fraction point to a s... Ver explicação completa e trilha adaptativa →