A 63-year-old woman has the sudden onset of "knife-like" pain in the chest radiating to the back. She has been previously healthy except for a history of poorly controlled hypertension. She is transported to the hospital and on arrival she has a heart rate of 90/minute, respirations 20/minute, temperature 36.8°C, and blood pressure 150/100 mm Hg. No murmurs, rubs, or gallops are audible. A chest radiograph reveals a widened mediastinum. Laboratory findings include a total serum creatine kinase of 55 U/L, creatinine 0.9 mg/dL, and glucose 123 mg/dL. Which of the following is the most likely diagnosis?
A Fibrinous pericarditis
B Aortic dissection
C Infective endocarditis
D Dilated cardiomyopathy
E Myocardial infarction
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A 45-year-old man was rushed to the hospital following the sudden onset of an episode of crushing substernal chest pain. He receives advanced life support measures. An EKG shows changes consistent with a large transmural anterolateral area of infarction involving wall of the left ventricle. He develops cardiogenic shock. Which of the following microscopic findings is most likely to be present in this area 4 days following the onset of his chest pain?
A Fibroblasts and collagen deposition
B Capillary proliferation and macrophages
C Myofiber necrosis with neutrophils
D Granulomatous inflammation
E Perivascular lymphocytic infiltrates
A 45-year-old woman has had worsening shortness of breath for 3 years. She now has to sleep sitting up on two pillows. She has had difficulty swallowing for the past year. She has no history of chest pain. A month ago, she had a "stroke" with resultant inability to move her left arm. She is afebrile. A chest radiograph reveals a near-normal left ventricular size with a prominent left atrial border. Which of the following conditions is most likely to account for her findings?
A Essential hypertension
C Mitral valve stenosis
D Aortic coarctation
E Patent foramen ovale
A 16-year-old healthy adolescent is involved in a schoolyard gang fight and is stabbed in the chest with a knife in the left midclavicular line. He is taken to the emergency department and on arrival his blood pressure is barely obtainable. His lungs are clear to auscultation. His heart sounds are barely audible. Which of the following is the most useful therapeutic approach for this boy?
A Coronary angioplasty
B Aortic repair
D Antibiotic therapy
E Antiarrhythmic drugs
A 19-year-old woman has had increasing malaise for the past 5 months. On physical examination she has a cardiac murmur characterized by a mid systolic click. An echocardiogram demonstrates mitral insufficiency with upward displacement of one leaflet. There is aortic root dilation to 4 cm. She has a dislocated right ocular crystalline lens. A year later she dies suddenly and unexpectedly. The medical examiner finds a prolapsed mitral valve with elongation, thinning, and rupture of chordae tendineae. A mutation involving which of the following genes is most likely to be present in this patient?
A 72-year-old woman has had no major illnesses throughout her life. She has had 3 syncopal episodes during the past 2 weeks. Over the past 2 days she has developed shortness of breath and a cough with production of frothy white sputum. On physical examination she is afebrile. Her blood pressure is 135/90 mm Hg. She has no peripheral edema. A chest radiograph reveals a prominent left heart border in the region of the left ventricle, but the other chambers do not appear to be prominent. There is marked pulmonary edema. Laboratory studies show a total serum cholesterol of 170 mg/dL. Which of the following is the most likely diagnosis?
A Acute rheumatic fever
B Mitral valve insufficiency
C Atherosclerotic aortic aneurysm
D Calcific aortic stenosis
E Infective endocarditis
A 17-year-old girl is short in stature for her age. She has not yet shown any changes of puberty. On physical examination her vital signs include T 37°C, RR 18/minute, P 75/minute, and BP 165/85 mm Hg. She has a continuous murmur heard over both the front of the chest as well as her back. Her lower extremities are cool with diminished pulses and poor capillary filling. She has a webbed neck. A chest radiograph reveals a prominent left heart border, no edema or effusions, and rib notching. Which of the following cardiovascular abnormalities is she most likely to have?
A Shortening and thickening of chordae tendineae of the mitral valve
B Narrowing of the aorta past the ductus arteriosus
C Supravalvular narrowing in the aortic root
D Lack of development of the spiral septum and partial absence of conus musculature
E Single large atrioventricular valve
A 65-year-old man has sudden onset of severe abdominal pain that has persisted for 3 hours. Physical examination reveals his temperature is 37°C, heart rate 110/minute, respirations 25/minute, and blood pressure 145/100 mmHg. He has diminished pulses in the lower extremities. There is a pulsatile abdominal mass. His serum creatine kinase is not elevated. He has had fasting blood glucose measurements in the range of 140 to 180 mg/dL for over 20 years. Which of the following conditions is he most likely to have?
A Superior mesenteric artery thrombosis
B Atherosclerotic aortic aneurysm
C Polyarteritis nodosa
D Acute coronary syndrome
E Monckeberg's medial calcific sclerosis
A 49-year-old woman had atrial fibrillation that was poorly controlled, even with amiodarone therapy. She suffered a "stroke" and died. At autopsy, her 600 gm heart is noted to have a mitral valve with partial fusion of the leaflets along with thickening and shortening of the chordae tendineae. There is an enlarged left atrium filled with mural thrombus. Which of the following underlying causes of death is she most likely to have?
A Systemic lupus erythematosus
B Coronary atherosclerosis
C Marantic endocarditis
D Rheumatic heart disease
E Cardiac amyloidosis
A 23-year-old woman has had worsening malaise along with a malar skin rash persisting for 3 weeks. On physical examination, she has an audible friction rub on auscultation of the chest, along with a faint systolic murmur. An echocardiogram reveals small vegetations on the mitral valve and adjacent ventricular endocardium. Laboratory studies show a positive serologic test for anti-Smith antibody, with a titer of 1:2048. Which of the following is the most likely diagnosis?
A Polyarteritis nodosa
B Scleroderma, diffuse
C Systemic lupus erythematosus
D ANCA-associated granulomatous vasculitis
E Adenocarcinoma of the pancreas
A 27-year-old G2 P1 woman has a screening ultrasound performed at 18 weeks gestation. The fetus is appropriate in size for 18 weeks. The fetal kidneys, liver, head, and extremities appear normal. However, the fetus has a heart with a membranous ventricular septal defect, overriding aorta, and marked pulmonic atresia. If the baby were to be liveborn, which of the following characteristics on physical examination would most likely result from these cardiac defects?
A Systemic hypertension
B Weak lower extremity pulses
C Clubbing of digits
A 50-year-old man has the sudden onset of substernal chest pain. The pain persists for the next three hours. He then becomes short of breath and diaphoretic. He goes to the emergency department and on physical examination his vital signs include T 37°C, P 100/minute, RR 26/minute, and BP 130/90 mm Hg. A chest x-ray shows a slightly enlarged heart and mild pulmonary edema. An EKG shows ST segment elevation in anterior leads V1 - 6. Which of the following serum laboratory test findings is most likely to be present in this man?
A Urea nitrogen of 110 mg/dL
B Sodium of 115 mmol/L
C ALT of 876 U/L
D Troponin I of 32 ng/mL
E HDL cholesterol of 55 mg/dL
A 44-year-old woman dies as a consequence of a "stroke". At autopsy, she is found to have a large right basal ganglia hemorrhage. She has an enlarged 550 gm heart with predominantly left ventricular hypertrophy. Her kidneys are small, about 80 gm each, with cortical scarring, and microscopically they demonstrate small renal arterioles that have luminal narrowing from concentric intimal thickening. Which of the following is the most likely condition associated with her findings?
A Autosomal dominant polycystic kidney disease
B Diabetes mellitus, type II
D Malignant hypertension
E Monckeberg's sclerosis
A 24-year-old woman with rheumatic heart disease becomes febrile. On physical examination she has a systolic murmur. An echocardiogram shows vegetations of the aortic valve cusps. A blood culture is positive for Staphylococcus epidermidis. She receives a porcine bioprosthesis because of her desire to have children and not to take anticoagulant medication. After ten years, she must have this prosthetic valve replaced. Which of the following pathologic findings in the bioprosthesis has most likely led to the need for replacement?
C Strut failure
A 25-year-old previously healthy woman collapses suddenly and unexpectedly. Echocardiography shows global hypokinesis with increased left ventricular end diastolic and systolic size, along with systolic left ventricular dysfunctionwith decreased ejection fraction. An endomyocardial biopsy is obtained and microscopically, the myocardium shows infiltration by small lymphocytes, with focal myocyte necrosis. Which of the following infectious agents is most likely to have caused these findings?
A Coxsackie B virus
B Candida albicans
C Aspergillus fumigatus
D Streptococcus, viridans group
E Staphylococcus aureus
G Streptococcus, group A
A 22-year-old man has had increasing malaise over the past 3 weeks. On physical examination his vital signs show T 39.2°C, P 105/minute, RR 30/minute, and BP 80/40 mm Hg. On auscultation of his chest a loud systolic cardiac murmur is heard, and his lungs have bibasilar crackles. Needle tracks are seen in his left antecubital fossa. He has splinter hemorrhages noted on fingernails, as well as painful erythematous nodules on palmar surfaces. A tender spleen tip is palpable. A chest radiograph shows pronounced pulmonary edema. Which of the following laboratory test findings is most likely to be present in this patient's peripheral blood?
A Creatine kinase-MB of 8% with a total CK 389 U/L
B Positive blood culture for Pseudomonas aeruginosa
C Total serum cholesterol of 374 mg/dL
D Blood urea nitrogen of 118 mg/dL
E Antinuclear antibody titer of 1:512
A 2-year-old child has had failure to thrive for a year, becoming increasingly listless. On examination she is found to have a soft, rumbling systolic ejection murmur. An echocardiogram reveals a large membranous ventricular septal defect. Which of the following complications is she most likely to experience as an adult 2 decades later if this lesion remains untreated?
A Rib notching
B Mitral valve prolapse
C Pulmonary hypertension
D Myocardial infarction
E Cardiac tamponade
A 43-year-old woman has noted increasing dyspnea for the past 6 years. On examination she is afebrile. Rales are auscultated in both lungs. A chest radiograph shows an enlarged cardiac silhouette and bilateral pulmonary edema. Past history reveals that, as a child she suffered recurrent bouts of pharyngitis with group A beta hemolytic streptococcal infections. Which of the following cardiac valves are most likely to be abnormal in this woman?
A Aortic and tricuspid
B Mitral and pulmonic
C Aortic and pulmonic
D Tricuspid and pulmonic
E Mitral and aortic
A 26-year-old previously healthy woman has had worsening fatigue with dyspnea, palpitations, and fever over the past week. On physical examination her vital signs show T 38.9°C, P 104/minute, RR 30/minute, and BP 95/65 mm Hg. Her heart rate is slightly irregular. An ECG shows diffuse ST-T segment changes. A chest x-ray shows mild cardiomegaly. An echocardiogram shows slight mitral and tricuspid regurgitation but no valvular vegetations. Laboratory studies show a troponin I of 12 ng/mL. She recovers over the next two weeks with no apparent sequelae. Which of the following laboratory test findings best explains the underlying etiology for these events?
A Anti-streptolysin O titer of 1:512
B Total serum cholesterol of 537 mg/dL
C Echovirus serologic titer of 1:160
D Blood culture positive for Streptococcus, viridans group
E ANCA titer of 1:80
A 45-year-old man has had no major medical problems throughout his life, except for arthritis pain involving all extremities for the past 5 years. He has had worsening orthopnea and pedal edema in the past 6 months. There is no chest pain. On examination he is afebrile. A chest radiograph shows cardiomegaly with prominent left and right heart borders, along with pulmonary edema. Laboratory studies show serum sodium 139 mmol/L, potassium 4.3 mmol/L, chloride 99 mmol/L, CO2 25 mmol/L, urea nitrogen 18 mg/dL, creatinine 1.3 mg/dL, and glucose 167 mg/dL. Which of the following additional laboratory test findings is he most likely to have?
A Spherocytes on his peripheral blood smear
B Hemoglobin of 10.7 g/dL with MCV of 72 fL
C Erythrocyte sedimentation rate of 79 mm/Hr
D Anti-centromere antibody titer of 1:320
E Serum ferritin of 800 ng/mL
A 37-year-old previously healthy man has had worsening dyspnea along with peripheral edema for the past two years. On physical examination he has diffuse crackles auscultated over both lungs. A chest radiograph shows that the heart nearly fills the chest. A chest CT scan demonstrates a 10 cm mass involving the right ventricle that appears to have areas of hemorrhage and necrosis within it. Which of the following neoplasms is this man most likely to have?
E Papillary fibroelastoma
F Kaposi sarcoma
A 20-year-old primigravida delivers a term baby girl following an uncomplicated pregnancy. No anomalies are noted at the time of birth. Five weeks later, the mother brings the baby to the clinic because she has difficulty breathing and occasionally turns pale. On physical examination a pansystolic murmur is audible. Which of the following congenital cardiac anomalies is most likely to be present in this infant?
A Hypertrophic subaortic stenosis
B Hypoplastic left heart syndrome
C Coarctation of the aorta
D Ventricular septal defect
E Bicuspid aortic valve
A 66-year-old man has had congestive heart failure with increasing pulmonary congestion and edema for the past year. He had been previously healthy all his life with no major illnesses. On physical examination his blood pressure is 125/85 mm Hg and he is afebrile. A systolic ejection click is auscultated. A chest x-ray shows cardiomegaly with a prominent left heart border and pulmonary edema. Laboratory studies show a serum glucose of 95 mg/dL and total serum cholesterol of 175 mg/dL. His serum creatine kinase is not elevated. Which of the following underlying diseases is he most likely to have?
A Alcoholic cardiomyopathy
B Calcified bicuspid aortic valve
C Tricuspid valve endocarditis
D Aortic dissection
A 35-year-old man was found down, was delirious, and talking incoherently. On examination in the emergency department his temperature is 39.3°C, pulse 110/minute, and blood pressure 70/palpable. He has a heart murmur, palpable spleen tip, and splinter hemorrhages of fingernails. Which of the following laboratory findings is most likely to be present in this man?
A Positive urine screen for opiates
B Elevated anti-streptolysin O (ASO)
C Increased urinary free catecholamines
D Elevated Coxsackie B viral titer
E Rising creatine kinase (CK) in serum
A 69-year-old woman with a 7 kg weight loss over the past 6 months now has developed painless jaundice over the past 2 weeks. On physical examination she is afebrile. An abdominal CT scan shows a large mass involving the head of the pancreas, along with widespread nodules in the liver. Nodules are seen in both lungs by chest radiograph. Which of the following cardiac abnormalities is she most likely to develop?
A Dilated cardiomyopathy
B Non-bacterial thrombotic endocarditis
C Acute fibrinous pericarditis
D Endocardial fibrosis
E Acute myocardial infarction
A 51-year-old woman has had several syncopal episodes over the past year. Each episode is characterized by sudden but brief loss of consciousness. She reports no chest pain. On physical examination her vital signs show T 36.9°C, P 80/minute, RR 16/minute, and BP 110/75 mm Hg. She has no pedal edema. On brain MR imaging there is a 1.5 cm cystic area in the left parietal cortex. A chest radiograph shows no cardiac enlargement, and her lung fields are normal. Her serum total cholesterol is 165 mg/dL. Which of the following cardiac lesions is she most likely to have?
A Cardiac amyloidosis
B Left atrial myxoma
C Tuberculous pericarditis
D Mitral valve prolapse
E Ischemic cardiomyopathy
A 58-year-old man develops deep venous thrombosis during a hospitalization for prostatectomy. He exhibits decreased mental status 10 days postoperatively, with right hemiplegia. A CT scan of the head shows an acute cerebral infarction in the distribution of the left middle cerebral artery. A chest radiograph reveals cardiac enlargement and prominence of the main pulmonary arteries consistent with pulmonary hypertension. Laboratory studies show a serum troponin I of <0.4 ng/mL. Which of the following lesions is most likely to be present on echocardiography?
A Coarctation of the aorta
B Tetralogy of Fallot
C Atrial septal defect
D Pulmonic stenosis
A 25-year-old man dies suddenly and unexpectedly while at a nightclub late one evening. The medical examiner performs an autopsy. There is no evidence for trauma on external examination of the body. There are no gross pathologic findings of internal organs. Postmortem toxicologic findings are significant for high blood levels of cocaine and its metabolite benzoylecgonine. Which of the following is the most likely histopathologic finding involving his heart?
A Contraction band necrosis
B Lymphocytic myocarditis
C Myofiber disarray
D Coronary thrombosis
E Pericardial tamponade
A 49-year-old man has the sudden onset of substernal chest pain with radiation to his left arm. This persists for the next 6 hours. He goes to the emergency department and on examination is afebrile. Laboratory studies show a serum troponin I of 18 ng/mL and CK-MB of 8%. Angiography reveals a thrombosis of the left anterior descending coronary artery. During the next 24 hours, which of the following is the most likely complication he will experience?
A Constrictive pericarditis
C Hepatic necrosis
A 60-year-old man had chest pain and was hospitalized. On the first day of admission, his CK-MB fraction was 9.8% with total CK of 423 U/L. A coronary angiogram revealed 75% stenosis of the left anterior descending artery. Four days later he suddenly becomes worse, with marked hypotension. A pericardiocentesis is performed and returns 150 cc of bloody fluid. Which of the following microscopic findings is most likely to be present in his left ventricular myocardium at the time of this hypotensive episode?
A Extensive transmural collagen deposition
B Lymphocytic infiltrates
C Coronary arterial dissection
D Necrosis with neutrophils and macrophages
E Interstitial edema and loss of myofiber cross striations
A 27-year-old man has become severely ill with fever and malaise over the past 3 days following tooth extraction. On examination he has a temperature of 38.8°C, heart rate of 105/minute, respiratory rate of 24/min, and blood pressure of 80/40 mm Hg. He has a widely split S2 heart sound and a rumbling mid-diastolic murmur. He has small hemorrhages visible on nail beds. His spleen tip is palpable. Which of the following cardiac conditions is most likely to predispose him to this acute illness?
A Hypoplastic left heart syndrome
B Atrial septal defect
C Chagas disease
D Coronary atherosclerosis
E Hypertrophic cardiomyopathy
An epidemiologic study of eating habits is performed. Dietary patterns of adult patients are recorded and compared to risk for cardiovascular diseases. It is observed that persons who eat bacon for breakfast are more likely to have cardiovascular disease than persons who eat oat bran cereal. Which of the following conditions is the "bacon" group most likely to have?
A Mitral annulus calcification
B Ventricular aneurysm
C Left atrial dilation
D Thoracic aortic aneurysm
E Aortic valve stenosis
A 74-year-old man has had increasingly severe headaches for 2 months, centered on the right. His vital signs include T 36.9°C, P 82/minute, RR 14/minute, and BP 130/85 mm Hg. There is a palpable tender cord-like area over his right temple. His heart rate is regular with no murmurs, gallops, or rubs. Pulses are equal and full in all extremities. A biopsy of this lesion is obtained, and microscopic examination reveals a muscular artery with luminal narrowing and medial inflammation with lymphocytes, macrophages, and occasional giant cells. He improves with a course of high-dose corticosteroid therapy. Which of the following laboratory test findings is most likely to be present with this man's disease?
A Erythrocyte sedimentation rate of 110 mm/hr
B Rheumatoid factor titer of 80 IU/mL
C HDL cholesterol of 15 mg/dL
D Anti-double stranded DNA titer of 1:1024
E pANCA titer of 1:160
A 17-year-old girl "blacks out" while out running for exercise one afternoon, as she has done for many years. Physical examination, chest radiograph, head CT scan, CBC, and chemistry panel are all normal. Over the next year, she develops mild dyspnea and fatigue. She experiences several episodes of near-syncope. After another syncopal episode, she is referred to a cardiologist who orders an EKG that shows changes of left ventricular hypertrophy and broad Q waves. An echocardiogram reveals left ventricular and septal hypertrophy, small left ventricle, and reduced septal excursion. The septum has a "ground glass" appearance. Which of the following is the most likely microscopic feature of her disease process?
A Aschoff bodies
D Myofiber disarray
E Atheroma formation
A 78-year-old woman has had increasing dyspnea for the past 5 years. On examination her blood pressure is 130/85 mm Hg. Her BMI is 35. Rales are auscultated in both lungs. Her B-type natriuretic peptide, C-reative protein and LDL cholesterol are elevated. A chest x-ray shows infiltrates in all lung fields and an enlarged heart. Echocardiography shows decreased ejection fraction with segmental wall motion abnormalities. Which of the following forms of cardiomyopathy is she most likely to have?
A 51-year-old man has the sudden onset of substernal chest pain which radiates to his left arm and neck. He becomes light-headed and diaphoretic over the next 3 hours. He goes to the emergency room. On examination he is afebrile but has a heart rate of 96/minute with an irregular rhythm. Laboratory studies show a serum CK-MB of 15% with total CK of 524 mg/dL. Which of the following features would be most prominent by histopathologic examination of his myocardium at this point in time?
A Macrophage infiltration
B Contraction band necrosis
C Neutrophilic infiltration
D Capillary proliferation
E Collagen deposition
A 58-year-old man has had an enlarging abdomen for 5 months. He has experienced no abdominal or chest pain. On physical examination he has a non-tender abdomen with no masses palpable, but there is a fluid wave. An abdominal CT scan shows a large abdominal fluid collection with a small cirrhotic liver. A chest radiograph shows a globally enlarged heart. He has vital signs showing T 37.1°C, P 78/minute, RR 16/minute, and BP 115/75 mm Hg. Which of the following cardiovascular conditions is he most likely to have?
A Severe occlusive coronary atherosclerosis
C Myocardial amyloid deposition
D Nonbacterial thrombotic endocarditis
E Dilated cardiomyopathy
A 77-year-old man with decreasing mental function has developed increasing dyspnea for the past 3 years. On physical examination he has a diastolic murmur. A chest CT scan shows an enlarged heart and prominent aorta. He dies from complications of pneumonia. At autopsy, the thoracic aorta is aneurysmally dilated. A microscopic section of the aorta shows chronic inflammation and luminal narrowing of vasa vasora. There is disruption of the aortic medial elastic fibers. Which of the following conditions is most likely to cause these findings?
B Marfan syndrome
D Takayasu arteritis
E Tertiary syphilis
F ANCA-associated vasculitis
A 23-year-old primigravida gives birth following an uncomplicated pregnancy to a 2870 gm girl infant. The baby initially does well, but 12 hours following delivery she develops respiratory difficulty. On examination the infant has a poor color, weak pulses, and oxygen saturation of only 90%. Which of the following cardiac findings is this infant most likely to have?
A Muscular ventricular septal defect
B Hypoplastic left heart
C Complete transposition with no shunt
D Secundum type atrial septal defect
E Congenital Group B Streptococcus infection
A 66-year-old man has had increasing malaise for the past year. On physical examination auscultation of the chest reveals a friction rub. Laboratory studies show a serum urea nitrogen of 100 mg/dL and creatinine of 9.8 mg/dL. Which of the following forms of pericarditis is he most likely to have?
A clinical study is performed to document complications in persons with glomerulonephritis and with laboratory studies showing an elevated antinuclear antibody and anti-ds-DNA titer. Which of the following cardiac abnormalities is most likely to be present?
B Libman-Sacks endocarditis
C Hemorrhagic pericarditis
D Lipofuscin deposition
E Coronary artery vasculitis
A 53-year-old man has had malaise for the past 3 months. On physical examination he is afebrile. On auscultation of the chest, heart sounds are distant and there is a friction rub. An echocardiogram shows a pericardial fluid collection. A pericardiocentesis yields 10 mL of bloody fluid. Which of the following conditions is most likely to give rise to these findings?
A Autoimmune disease
B Chronic renal failure
C Rheumatic fever
D Metastatic carcinoma
A 56-year-old man has a routine checkup. He is found to have a blood pressure of 175/110 mm Hg. A month later his blood pressure is 170/105 mm Hg. He elects to do nothing about this, because he feels fine. If he remains untreated, this man is at greatest risk for which of the following conditions?
A Pleural effusions
B Pulmonary congestion
C Hyperplastic arteriolosclerosis
D Tricuspid insufficiency
A 48-year-old man has had worsening severe headaches over the past 3 months. There are no abnormal findings on physical examination. Brain MR imaging shows a large 8 cm mass in the right posterior parietal region that extends across the splenium of the corpus callosum. A stereotaxic biopsy reveals an anaplastic astrocytoma. He is treated with radiation and chemotherapy. Two months later he experiences left upper quadrant abdominal pain, accompanied by hematuria. He then has an episode of sudden dyspnea and a chest CT scan shows large thromboemboli filling both main pulmonary arterial branches. Which of the following cardiovascular lesions is most likely to be found in this man?
A Tear in the ascending aortic intima
B Occlusive coronary atheromatous plaques
C Hypertrophic cardiomyopathy
D Epicardial metastases
E Mitral marantic vegetations
A 50-year-old man has noted increasing swelling of his lower legs along with shortness of breath for 5 months. On physical examination he is afebrile, but diffuse crackles are heard over the lung bases. His heart rate is 80/minute and regular, with no murmurs, rubs, or gallops, but there is a prominent widened split S2. A chest radiograph reveals an increased size to the right heart border, along with bilateral pleural effusions. Laboratory studies show a serum troponin I of <0.4 ng/mL. Which of the following conditions is he most likely to have?
B Viral myocarditis
C Bicuspid aortic valve
D Constrictive pericarditis
E Pulmonary interstitial fibrosis
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