A 60-Year-Old Man Has Experienced Progressive Shortness of Breath Over

A 60-year-old man has experienced progressive shortness of breath over the last 6 months that is occasionally accompanied by chest pain.  He was diagnosed with hypertension 10 years ago.  Twenty years ago, he suffered from advanced-stage Hodgkin lymphoma that was treated with combination chemotherapy and radiation therapy.  He is a lifetime nonsmoker.  Blood pressure is 138/90 mm Hg and pulse is 78/min and regular.  Physical examination shows a 2/4 early diastolic murmur at the left sternal border.  Echocardiogram shows an enlarged left atrium, a normal-size left ventricle with an ejection fraction of 60%, and moderate diastolic dysfunction.  Both the mitral and aortic valves appear sclerotic and calcified.  The aortic root is normal-size but is echo bright.  There is moderate aortic regurgitation.  Cardiac catheterization shows ostial narrowing of the right and left main coronary arteries.  Which of the following is the most likely diagnosis?

A) Anthracycline cardiotoxicity
B) Hypertensive heart disease
C) Radiation cardiotoxicity
D) Rheumatic heart disease
E) Secondary malignancy

Correct Answer:

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