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