An 82-Year-Old Man Comes to the Office Due to Progressive

question 605

Multiple Choice

An 82-year-old man comes to the office due to progressive dyspnea and fatigue over the last year, which now limit his daily activities.  He has also noticed bilateral swelling of his feet.  The patient has hypertension, which is controlled with amlodipine.  His blood pressure is 122/72 mm Hg and pulse is 55/min.  Physical examination reveals elevated jugular venous pressure with rapid 'y' descent and a prominent S4.  Abdominal examination shows moderate ascites.  The patient has 3+ bilateral lower extremity pitting edema.  Echocardiogram reveals left atrial enlargement with marked left ventricular hypertrophy and normal left ventricular ejection fraction.  Complete blood count and basic metabolic panel are within normal limits.  Endomyocardial biopsy findings are shown below. Which of the following is the most likely diagnosis?

• A)Cardiac myxoma
• B)Cardiac sarcoidosis
• C)Chagas disease
• D)Hemochromatosis
• E)Senile amyloidosis

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