A 52-Year-Old Man Comes to the Physician Because of a 2-Month

A 52-year-old man comes to the physician because of a 2-month history of palpitations. He says that he can feel his heartbeat in his chest all the time. For the past 3 weeks, he has had shortness of breath on exertion. He has not had chest pain, orthopnea, or nocturnal dyspnea. He has a history of intravenous drug use and diagnosed with infective endocarditis which was successfully treated with a long course of antibiotics. He emigrated from Nepal at the age of 25 years. His temperature is 36.5°C (97.7°F) , pulse is 103/min, and blood pressure is 145/56 mm Hg. Chest auscultation reveals a decrescendo diastolic murmur over the third intercostal space along the left sternal border.  Echocardiogram shows severe aortic regurgitation, likely as a sequela to the prior infection.  Which of the following changes is most responsible for maintaining cardiac output in the setting of this valvular abnormality?

A) Concentric left ventricular hypertrophy
B) Decrease in left ventricular preload
C) Increase in aortic elasticity
D) Increase in left ventricular afterload
E) Increase in left ventricular stroke volume
F) Sustained increase in heart rate

Correct Answer:

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