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Heart failure with preserved ejection fraction — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Heart failure with preserved ejection fractionUSMLE Step 3

A 67-year-old woman has progressive exertional dyspnea, orthopnea, and ankle swelling. She has longstanding hypertension. Echocardiography shows ejection fraction 60%, concentric left ventricular hypertrophy, and impaired diastolic filling. BNP is elevated. Which of the following is the most likely diagnosis?

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Correct answer: C — Heart failure with preserved ejection fraction

Congestive symptoms with preserved ejection fraction and diastolic dysfunction in an older hypertensive patient indicate HFpEF.

Reference: ACC/AHA/HFSA heart failure guideline