A 78-Year-Old Man Comes to the Office Due to Lower

A 78-year-old man comes to the office due to lower extremity swelling.  He has had progressive exertional dyspnea over the past 2 years.  Over the past 2 months, the patient has noticed lower extremity swelling, decreased appetite, and increased abdominal girth.  He has a history of poorly controlled hypertension but no known coronary artery disease.  The patient is a lifetime nonsmoker.  He has no history of prior surgeries.  Blood pressure is 165/88 mm Hg and pulse is 72/min and regular.  He is afebrile.  On physical examination, the jugular veins are distended and there are prominent V waves.  A holosystolic murmur is heard at the lower sternal border, and there is 3+ pitting edema of the lower extremities bilaterally.  Which of the following best explains the physical examination findings in this patient?

A) Dilation of the pulmonary arteries
B) Dilation of the tricuspid valve annulus
C) Flailing of a tricuspid valve leaflet
D) Fusion of the tricuspid valve commissures
E) Increased intrapericardial pressure

Correct Answer:

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