A 63-Year-Old Man Comes to the Office Due to Exertional

A 63-year-old man comes to the office due to exertional dyspnea that has been progressively worsening over the last 3 weeks.  He sleeps in a recliner with his head elevated because he gets short of breath when lying flat in bed.  Medical history includes gout, dyslipidemia, and hypertension.  Blood pressure is 154/89 mm Hg and pulse is 85/min.  Physical examination shows distended jugular veins in the semi-recumbent position.  An apical heave is present on cardiac examination.  There is pitting edema in the bilateral lower extremities. aboratory testing reveals elevated brain natriuretic peptide levels.  Which of the following is the primary trigger for the release of this substance in this patient?

A) Activation of alveolar juxtacapillary receptors
B) Decrease in renal perfusion pressure
C) Decrease in vena cava blood return
D) Focal myocardial necrosis
E) Increase in ventricular wall stress
F) Stretching of aortic baroreceptors

Correct Answer:

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