A 68-year-old man with prior anterior myocardial infarction presents with exertional dyspnea, orthopnea, and bilateral ankle edema. Vital signs show BP 128/82 mmHg, HR 94 bpm, RR 18/min, and SpO2 98% on room air. Echocardiography reveals diffuse hypokinesis with ejection fraction of 28%. BNP is elevated at 450 pg/mL. He denies chest pain. Currently on aspirin but not on ACE inhibitors. Which neurohormonal change most likely contributes to disease progression?
- A)Activation of the renin angiotensin aldosterone systemGABARITO
- B)Suppression of sympathetic tone
- C)Decreased renin secretion
- D)Increased atrial natriuretic peptide causing ventricular fibrosis
- E)Reduced norepinephrine release
Explicação
Activation of the renin angiotensin aldosterone system is correct. Reduced forward cardiac output in HFrEF triggers RAAS activation, increasing afterload, sodium retention, and maladaptive remodeling that worsens disease over time. This is why ACE inhibitors, ... Ver explicação completa e trilha adaptativa →