A 44-Year-Old Man Comes to the Office Due to Persistent

A 44-year-old man comes to the office due to persistent cough and dyspnea on exertion for approximately the last 3 months.  He has had no fever, chills, rhinorrhea, or sputum production.  Over the past year, the patient has had progressively worsening shortness of breath and is unable to sleep lying flat.  He has no chest pain or diaphoresis but has had palpitations previously.  The patient does not use tobacco or alcohol.  He moved to the United States from Southeast Asia 10 years ago.  On examination, the patient is alert but in mild distress.  Temperature is 36.7 C (98 F) , blood pressure is 110/70 mm Hg, and pulse is 100/min.  BMI is 34 kg/m².  Heart sounds are distant due to body habitus.  The lungs demonstrate crackles on auscultation.  Chest x-ray reveals an enlarged cardiac silhouette with vascular congestion.  The left main stem bronchus appears to be elevated.  There is no other visible lung pathology.  ECG shows an irregularly irregular rhythm.  Which of the following is the most likely cause of this patient's presentation?

A) Acute pericarditis
B) Interstitial lung disease
C) Lung cancer
D) Rheumatic heart disease
E) Sarcoidosis

Correct Answer:

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