An 80-year-old man is being evaluated for follow up health maintinance. he states that he feels shortness of breath after walking a short distant and should stop to catch up the breath. The patient has long-standing hypertension and iritable bowel syndrome but has not always been adherent to his medical regimen. he was smoking 30 packs per year and stopped 15 years ago after his friend died with a myocardial infarction. Blood pressure is 160/74 mm Hg and pulse is 86/min and regular. An S4 is heard on cardiac auscultation. The lungs are clear. Echocardiogram reveals left atrial enlargement, moderate concentric left ventricular hypertrophy, and a left ventricular ejection fraction of 67%. Which of the following changes are most likely to be seen in this patient?

Question

An 80-year-old man is being evaluated for follow up health maintinance. he states that he feels shortness of breath after walking a short distant and should stop to catch up the breath. The patient has long-standing hypertension and iritable bowel syndrome but has not always been adherent to his medical regimen.  he was smoking 30 packs per year and stopped 15 years ago after his friend died with a myocardial infarction. Blood pressure is 160/74 mm Hg and pulse is 86/min and regular.  An S4 is heard on cardiac auscultation.  The lungs are clear.  Echocardiogram reveals left atrial enlargement, moderate concentric left ventricular hypertrophy, and a left ventricular ejection fraction of 67%.  Which of the following changes are most likely to be seen in this patient?

Quizplus · Accepted Answer

Eductional Objective: Prolonged systemic hypertension leads to concentric left ventricular (LV) hypertrophy via the addition of myocardial contractile fibers in parallel.  The thickening of the LV walls reduces LV compliance, leading to impaired diastolic filling and heart failure with preserved ejection fraction.  In response to reduced cardiac output, the kidneys activate the renin-angiotensin-aldosterone system, stimulating sodium retention and vasoconstriction that worsens volume overload and can lead to decompensated heart failure.

An 80-Year-Old Man Is Being Evaluated for Follow Up Health