44-year-old Asian immigrant comes to the physician complaining of a persistent cough and dyspnea on exertion for about 3
months. He has no fever, chills, runny nose, or sputum production Over the past year, he has had progressively worsening
shortness of breath and is unable to sleep lying flat He has no chest pain or diaphoresis but has had palpitations in the past He
does not smoke or drink alcohol. The patient moved to the United States 10 years ago. He is alert but in mild distress. His
temperature is 36.7° C (98° F), blood pressure is 110/70 mm Hg, and pulse is 100/min. His body mass index is 34 kg/m2 Heart
sounds are distant due to body habitus. Lung examination shows crackles. The chest-x ray reveals an enlarged cardiac silhouette
with vascular congestion The left main stem bronchus appears to be elevated. There is no other visible lung pathology. The
electrocardiogram shows irregularly irregular rhythm. The pathophysiology of this condition is related to which of the following?
- QA Acute pericarditis
- 0 B. Interstitial lung disease
- 0 C. Malignancy
- 0 D. Rheumatic heart disease
- 0 E. Sarcoidosis
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