A 60-Year-Old Previously Healthy Woman Is Evaluated for Progressively Worsening

A 60-year-old previously healthy woman is evaluated for progressively worsening fatigue, exertional dyspnea, and lower extremity swelling.  The patient also bruises easily and was recently found to have significant proteinuria.  She takes no medications but has a 10-pack-year smoking history and drinks 2 or 3 glasses of wine daily.  Temperature is 37.1 C (98.8 F) , blood pressure is 130/70 mm Hg, pulse is 80/min, and respirations are 14/min.  Examination shows jugular venous distension.  The lungs are clear to auscultation.  Echocardiography shows small pericardial effusion and concentric thickening of the ventricular walls with diastolic dysfunction.  Ventricular chamber dimensions are normal.  Which of the following is the most likely cause of this patient's symptoms?

A) Alcohol-related heart disease
B) Amyloidosis
C) Constrictive pericarditis
D) Hemochromatosis
E) Sarcoidosis

Correct Answer:

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