A 65-Year-Old Man Comes to the Physician Because of a 10-Day

A 65-year-old man comes to the physician because of a 10-day history of episodic retrosternal pain and shortness of breath. The episodes occur when he climbs stairs or tries to walk briskly on his treadmill. The symptoms resolve with rest. The previous evening he felt dizzy and weak during such an episode. Physical examination shows a mid-systolic murmur at the upper sternum and slow-rising carotid pulses.  After initial evaluation, cardiac catheterization is performed and reveals 30% stenosis of the mid-left anterior descending artery.  A 50 mm Hg pressure gradient is seen when a catheter is passed across the aortic valve.  Which of the following is the most important contributor to this patient's presenting symptoms?

A) Decrease in coronary blood supply due to lipid-rich plaque
B) Decrease in coronary blood supply due to vasospasm
C) Decrease in left ventricular compliance
D) Increase in left ventricular stroke volume
E) Increase in left ventricular wall stress

Correct Answer:

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