A 68-Year-Old Man Comes to the Office Due to Exertional

A 68-year-old man comes to the office due to exertional shortness of breath and fatigue, which have progressed over the past year.  The patient has a history of hypertension, but medical history is otherwise unremarkable.  He is a lifetime nonsmoker.  His father died of a "heart attack" at age 70.  Blood pressure is 144/74 mm Hg, and pulse is 72/min and regular.  Cardiac auscultation reveals a 3/6 ejection-type, late-peaking systolic murmur and a barely audible S2.  The murmur diminishes in intensity during the straining phase of the Valsalva maneuver.  Which of the following processes underlies this patient's current condition?

A) Cardiomyocyte hypertrophy and disarray causing asymmetric septal thickening
B) Differentiation of valve fibroblasts into osteoblast-like cells
C) Myxomatous valve thickening and elastin fragmentation
D) Subendocardial granulomatous lesions with fibrinoid necrosis and subsequent fibrosis
E) Thrombus formation on inflamed valvular endothelium

Correct Answer:

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