American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a common outcome of microvascular cardiomyopathy seen in systemic sclerosis?

1. Atrial fibrillation

2. Heart failure

3. Mitral valve prolapse

4. Congestive heart failure

The correct answer is: Heart failure

Microvascular cardiomyopathy is a cardiac manifestation that can emerge in patients with systemic sclerosis (scleroderma). This condition often leads to structural and functional changes in the heart due to alterations in the small blood vessels that supply the heart muscle, ultimately resulting in impaired myocardial perfusion and function. The most common and significant outcome associated with microvascular cardiomyopathy in systemic sclerosis is the development of heart failure. This may arise from various mechanisms, including fibrosis of the myocardium, diastolic dysfunction, and reduced ejection fraction due to inadequate blood supply and oxygenation of cardiac tissues. Heart failure in this context is characterized by symptoms such as shortness of breath, fatigue, and swelling in the legs due to fluid retention, reflecting the heart's inability to pump effectively. Patients with systemic sclerosis often have other risk factors that contribute to heart failure, including pulmonary hypertension, which can worsen cardiac function. While atrial fibrillation, mitral valve prolapse, and congestive heart failure can be seen in various cardiac conditions, the specific outcome of microvascular cardiomyopathy in the setting of systemic sclerosis predominantly manifests as heart failure. Congestive heart failure, in particular, refers to the clinical heart failure syndrome that involves fluid overload and is