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Cardiology MCQ

 Question:

A 55-year-old man presents with dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. On examination, he has bibasal crackles, elevated jugular venous pressure, and an S3 heart sound. Echocardiography shows reduced ejection fraction of 35%. What is the most likely diagnosis?

Options:

A. Constrictive pericarditis

B. Systolic heart failure (HFrEF)

C. Diastolic heart failure (HFpEF)

D. Restrictive cardiomyopathy

✅ Answer: B. Systolic heart failure (HFrEF)

Explanation:

This patient has classic symptoms of heart failure: dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea.

Physical signs: bibasal crackles (pulmonary congestion), elevated JVP (right-sided pressure), S3 gallop (ventricular systolic dysfunction).

Echocardiography shows reduced ejection fraction (<40%), which defines HFrEF (heart failure with reduced ejection fraction).

Diastolic heart failure (HFpEF) typically presents with preserved EF (>50%), often in elderly hypertensive patients, with less prominent pulmonary congestion.

Constrictive pericarditis shows signs of Kussmaul’s sign, pericardial knock, and imaging reveals thickened pericardium, not reduced EF.

Restrictive cardiomyopathy may mimic HFpEF with preserved EF but is usually associated with biatrial enlargement and restrictive filling pattern on echo.

Management: HFrEF treatment includes ACE inhibitors/ARBs, beta-blockers, diuretics for congestion, aldosterone antagonists, and device therapy (ICD/CRT) depending on severity.





References:

Harrison’s Principles of Internal Medicine, 21st Edition, Ch. 220–221

Braunwald’s Heart Disease, 12th Edition, Ch. 43

UpToDate: Approach to heart failure in adults

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