A 63-Year-Old Man Comes to the Emergency Department with 2

A 63-year-old man comes to the emergency department with 2 hours of chest pain and shortness of breath.  The pain started as lower sternal discomfort that he attributed to indigestion, but then spread all over the anterior chest.  The patient has never had similar pain before.  Medical history includes hypertension, hyperlipidemia, and diet-controlled type 2 diabetes mellitus.  The patient is an ex-smoker with a 20-pack-year history.  On cardiac auscultation, a systolic murmur is heard.  Basilar crackles are present on both sides.  After initial evaluation, the patient is taken to the cardiac catheterization laboratory and is found to have a coronary artery occlusion, which is successfully revascularized.  The next morning, the patient appears comfortable and wants to go home.  The lungs are clear on auscultation, and no heart murmur is present.  The murmur heard during initial presentation is most likely explained by a pathologic process involving which of the following structures?

A) Aortic root
B) Aortic valve leaflets
C) Interventricular septum
D) Mitral valve chordae
E) Papillary muscle

Correct Answer:

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