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NBME 24 Answers

nbme24/Block 1/Question#48 (27.3 difficulty score)
A 70-year-old man is brought to the emergency ...
Stroke volume: decreased;
Left ventricular end-diastolic volume: increased;
Cardiac output: decreased


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submitted by tiredofstudying(54),

Radshopeful had a good explanation but a few typos may confuse people, so to recap:

The patient is suffering from systolic HF secondary to chronic HTN. The LV has lost contractile function (decreased LV systolic function from Qstem) which leads to decreased SV (and subsequently decreased CO since CO = HR x SV, the HR in this patient is also within normal limits). Finally, LVEDV is the amount of volume left in the LV at the end of diastole (or filling) and since the blood from systole was not able to be pumped forward efficiently (decreased SV) this leftover blood will cause this value to be increased.

submitted by radshopeful(19),
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xxabi  Great explanation - I think you have a minor typo, LVEDV will be increased* bc SV is decreased +15  
smoothie  More blood left in the ventricle after systole is LVESV. I thought LVEDV increases because more blood remains after systole and on top of that blood from left atria from diastole is now also added. +5  

submitted by an_improved_me(18),

Question i have is:

Does it matter if the cardiomypathy is eccentric vs. concentric? I feel like it might.

This pt likely has concentric cardiomypathy (i.e. diastolic), as others have mentioned, due to chronically untreated HTN. This leads to a decreased LV chamber size, and difficulty with myocardial relaxation. So my question is... If the problem in this pt is one of relaxation, and not so much of contraction. In this case, to me it would make sense to some extent, that LV EDV would actually be relatively decreased.

In fact, diastolic heart failure is associated with preserved EF (SV / EDV); this is both due to a decrease in SV and EDV.

I completely understand how EDV would increase in the ase of systolic (eccentric HF). The dilated heart can readily accept blood, but has problems pumping it out (i.e. decreased SV with an increased EDV. Let me know what you all think.

an_improved_me  I made a mistake above ^, this pt has a sytolic heart failure (despite chronic HTN...) as the question states it clearly ("echo shows decreased LV systolic function") +