A 64-Year-Old Man Is Evaluated for Lower Extremity Edema and Increasing

A 64-year-old man is evaluated for lower extremity edema and increasing abdominal discomfort.  His past medical history is significant for diet-controlled type 2 diabetes mellitus and mitral valve repair surgery 12 years ago.  He has smoked a pack of cigarettes daily for the last 40 years.  His blood pressure is 142/80 mm Hg, and pulse is 92/min and regular.  Jugular venous pressure is estimated at 16 cm H₂O.  A middiastolic sound is heard on cardiac auscultation.  Lungs are clear to auscultation.  There is significant ascites and 4+ lower extremity edema bilaterally.  Laboratory values show serum albumin level of 3.2 g/dL.  24-hour urine protein excretion is 280 mg.  Chest x-ray reveals normal heart size, clear lung fields, and spotty calcifications along the left heart border.  Echocardiogram shows enlarged atria, normal left ventricular wall thickness, normal right ventricular size, and left ventricular ejection fraction of 65%.  There is mild mitral regurgitation.  Which of the following is the most likely cause of this patient's symptoms?

A) Cardiac amyloidosis
B) Constrictive pericarditis
C) Cor pulmonale
D) Coronary artery disease
E) Hypertensive heart disease
F) Hypertrophic cardiomyopathy
G) Inferior vena cava obstruction
H) Stress-induced cardiomyopathy
I) Superior vena cava syndrome
J) Valvular heart disease

Correct Answer:

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