A 53-Year-Old Man Is Admitted to the Hospital with a 4-Week

A 53-year-old man is admitted to the hospital with a 4-week history of fatigue and decreased exercise tolerance.  Climbing 2 flights of stairs causes significant dyspnea.  He has had occasional palpitations for months but no chest pain.  Medical history is unremarkable, and a routine checkup 6 months ago was normal.  The patient had 2 binge-drinking episodes last month but usually drinks only in moderation.  He does not routinely take any medications.  Blood pressure is 150/90 mm Hg and pulse is 130/min and irregular.  Lungs are clear on auscultation.  ECG shows no clear P waves.  Echocardiography shows left atrial dilation, left ventricular dilation with global hypokinesis and an ejection fraction of 35%, and moderate central mitral regurgitation.  Which of the following interventions is most likely to restore left ventricular function in this patient?

A) Coronary revascularization
B) Decreasing afterload
C) Inotropic medications
D) Preload optimization
E) Rate or rhythm control
F) Valve surgery

Correct Answer:

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