65-year-cid man with known ischemic cardiomyopathy comes to the office due to 2 weeks of progressive shortness of breath and
nonproductive cough One week ago, he was instructed to increase his furosemide dose, but it did not seem to help. He has had no
chest pain or orthopnea. He takes all of his medications as directed and comes to all of his clinic visits. The patient had a myocardial
infarction 5 years ago and has severe left ventricular systolic dysfunction with an ejection fraction of 20%. He has an automatic
implantable cardioverter-Oefibrillator (AICD). Six months ago, he was hospitalized with recurrent AICD shocks due to ventricular
tachycardia; he was successfully treated with antiarrhythmic therapy, which he is currently still taking He is afebrile. His blood
pressure is 122/70 mm Hg and his pulse is 68/min aod regular His mucous membranes are moist His jugular veins are flat while he
is in a seated position Bilateral inspiratory crackles are heard on lung auscultation. There are no cardiac murmurs. There is no
significant peripheral edema. Chest x-ray reveals bilateral lung infiltrates involving primarily the middle lung fields Which of the following is the most likely cause of this patient’s current symptoms?
- QA Advanced heart failure
- QB Antiarrhythmic toxicity
- QC Diuretic toxicity
- QD Tricuspid valve insufficiency
- Q E Viral pneumonia
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