NBME 18 Answers ↦
is this super out of left field or am I supposed to know this
@motherhen I don't know if this is correct, but I personally tried to reason this one out. If hypertrophy is occurring, more sarcomeres are added which means more beta-myosin. Hypertrophy also means the cell is doing more work, so a transcription factor is likely to be upregulated. From there, the only option with both of those increased had endothelin increased as well, though unclear why that's necessarily increased.
Loud S2 made me think of pulmonary hypertension which would have an incr endothelin
that loud s2 was from systemic hypertension.
systemic hypertension -> induce LV hypertrophy -> induce pulmonary hypertension -> endothelin increase, plus loud S2 and S4 gallop