A 72-Year-Old Man Comes to the Office Due to Progressive

A 72-year-old man comes to the office due to progressive shortness of breath.  Over the past year, the patient has been unable to perform many of his usual outdoor activities, including afternoon walks and working in the yard.  During the last several weeks, he has frequently become easily fatigued and short of breath, and at night he needs several pillows to sleep comfortably.  He has also had ankle swelling.  The patient has had no chest pain, syncope, abdominal pain, or cough.  He is a lifetime nonsmoker.  Bibasilar crackles are heard on physical examination.  Echocardiography reveals no valvular disease and a nondilated left ventricle with an ejection fraction of 55%.  Which of the following is most strongly associated with this patient's current condition?

A) Glomerular hyperfiltration
B) Increased left ventricular afterload
C) Increased left ventricular compliance
D) Left ventricular thrombus formation
E) Right-to-left intracardiac shunting

Correct Answer:

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