80-year-Old woman comes to the office due to progressive lower extremity edema

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80-year-Old woman comes to the office due to progressive lower extremity edema over the last 2 months Her mobility is impaired

due to knee osteoarthntJs, but recently she has become somewhat tired and short of breath with daily actIvrt􀂵 Her stomach feels full

and her appe1I\e has been decreased The patient has had no forgetfulness or mood problems Blood pressure Is 140ll5 mm Hg and

pulse Is 70/min and regular Jugular veins are distended with the patient In tile seated posI\1on There are no heart murmurs. Breath

sourids are decreased at the bases bllaterally. The abdomen JS distended with flank dullness on percusslOfl There is 3+ peripheral

edema Laboratory results are as follows

Hemoglobin 11 2 g/dl

Sodium

Creatinine

132mEq/L

09mg/dl

Unne protein excretion Is 1 g/24 hr Echocardiogram reveals left atnal enlargement, marked concentnc left ventncular hypertrophy,

and left ventricular ejection fraction of 70%. Which of the following Is the most likely cause of this patient’s symptoms?

  • Q A HypertrophIc cardIomyopathy
  • QB lnfenor vena cava thrombosis
  • QC lschemic cardIomyopathy
  • Q D Protein malnutrition
  • 0 E Renal disease
  • Q F Restnct1ve cardIomyopathy
  • Q G Th1amIne deficIency

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