Systolic and diastolic heart failure mechanisms and the dilated, hypertrophic, and restrictive cardiomyopathy subtypes tested on USMLE Step 1.
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- What ejection fraction defines systolic heart failure (HFrEF)?
- EF less than 40%.
- What is the primary defect in systolic heart failure?
- Impaired ventricular contractility.
- What happens to stroke volume in systolic heart failure?
- It decreases due to reduced contractility.
- What type of hypertrophy develops in dilated cardiomyopathy and volume-overloaded systolic failure?
- Eccentric hypertrophy.
- In eccentric hypertrophy, how are new sarcomeres added?
- In series.
- What ejection fraction defines diastolic heart failure (HFpEF)?
- EF 50% or greater (preserved).
- What is the primary defect in diastolic heart failure?
- Impaired ventricular relaxation and filling.
- What type of hypertrophy is typically seen in diastolic heart failure from chronic hypertension?
- Concentric hypertrophy.
- In concentric hypertrophy, how are new sarcomeres added?
- In parallel.
- Which extra heart sound is classically associated with systolic (volume overload) heart failure?
- S3 (third heart sound).
- Which extra heart sound is classically associated with diastolic (stiff ventricle) heart failure?
- S4 (fourth heart sound).
- What law describes increased stroke volume in response to increased ventricular filling (preload)?
- The Frank-Starling law.
- Name the neurohormonal system activated in heart failure that increases blood volume and afterload.
- The renin-angiotensin-aldosterone system (RAAS).
- What is the effect of chronic sympathetic activation in heart failure on the heart?
- Increased heart rate and contractility, but it worsens remodeling over time.
- Which chamber primarily secretes BNP in response to increased wall stretch?
- The ventricles.