A 60-Year-Old Man Comes to the Physician Because of Progressive

A 60-year-old man comes to the physician because of progressive shortness of breath for 2-hour. The dyspnea occurs on moderate exertion and during the night; he sometimes wakes up coughing and "gasping for air." He has also had several episodes of heart pounding. Two weeks ago, he had a runny nose and a productive cough. He has type 2 diabetes mellitus and peripheral arterial disease. He has never smoked. He drinks one to two beers occasionally. He has a history of intravenous illicit drugs use but has not used in over 25 years. Current medications include aspirin, atorvastatin, and metformin. Blood pressure is 98/60 mm Hg and pulse is 112/min and regular.  A short systolic murmur is heard at the apex.  Bilateral crackles are present on lung auscultation.  Bedside echocardiography reveals a flail posterior mitral leaflet due to chordal rupture and severe mitral regurgitation.  Which of the following best reflects this patient's left ventricular hemodynamics compared to the normal heart?

A) Afterload decrease, preload decrease, ejection fraction decrease
B) Afterload decrease, preload increase, ejection fraction increase
C) Afterload increase, preload decrease, ejection fraction decrease
D) Afterload increase, preload decrease, ejection fraction increase
E) Afterload increase, preload increase, ejection fraction increase

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