American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the most common symptomatic manifestation of heart involvement in systemic sclerosis?

1. Arrhythmias

2. Microvascular cardiomyopathy

3. Myocardial infarction

4. Pericardial effusion

The correct answer is: Microvascular cardiomyopathy

The most common symptomatic manifestation of heart involvement in systemic sclerosis is microvascular cardiomyopathy. This condition is characterized by impairment of the microvasculature and is often associated with the fibrotic changes that occur in the heart tissue of patients with systemic sclerosis (scleroderma). Microvascular cardiomyopathy leads to complications such as heart failure due to the poor perfusion of the cardiac muscle, and patients may present with symptoms such as fatigue, exertional dyspnea, and heart palpitations. In systemic sclerosis, the heart can be affected by several mechanisms including fibrosis of the myocardium, which contributes to the diffuse involvement of the cardiac structure, making microvascular dysfunction a significant consequence. While other conditions such as arrhythmias, myocardial infarction, and pericardial effusion can occur in patients with systemic sclerosis, they are not as common or as directly related to the primary pathophysiological processes of the disease. Arrhythmias can result from underlying structural changes but are secondary to the primary issue of microvascular involvement. Similarly, myocardial infarction is not a typical manifestation as it often requires the presence of significant coronary artery disease, which is not a primary characteristic of systemic sclerosis. Pericardial effusion can