01-23-2008, 06:21 PM
_ A 75-year-old man presents with recurrent episodes
of shortness of breath on minimal exertion. He has
no prior signiï¬cant past medical history. Physical examination
reveals blood pressure of 110/70 without pulsus paradoxus, heart rate of 110, respiratory rate of 25, and temperature of 37C (98.6F) orally. Jugular veins are distended and the heart sounds are distant, but there are third and fourth extra heart sounds. The liver is enlarged, and pedal edema is present. The electrocardiogram shows nonspeciï¬c ST-T wave changes and occasional premature ventricular contractions. The chest x-ray reveals clear lung ï¬elds and a mildly dilated cardiac silhouette. Echocardiography reveals normal systolic function and thickened ventricular walls with a œspeckled appearance. Which of the following conditions is most consistent with the patient™s clinical presentation?
(A) Alcoholic cardiomyopathy
(B) Hemochromatosis
© Amyloidosis
(D) Viral myocarditis
(E) Tuberculosis