A 68-Year-Old Man Comes to the Office Due to Exertional

question 736

Multiple Choice

A 68-year-old man comes to the office due to exertional shortness of breath and fatigue, which have progressed over the past year.  The patient has a history of hypertension, but medical history is otherwise unremarkable.  He is a lifetime nonsmoker.  His father died of a "heart attack" at age 70.  Blood pressure is 144/74 mm Hg, and pulse is 72/min and regular.  Cardiac auscultation reveals a 3/6 ejection-type, late-peaking systolic murmur and a barely audible S2.  The murmur diminishes in intensity during the straining phase of the Valsalva maneuver.  Which of the following processes underlies this patient's current condition?

• A)Cardiomyocyte hypertrophy and disarray causing asymmetric septal thickening
• B)Differentiation of valve fibroblasts into osteoblast-like cells
• C)Myxomatous valve thickening and elastin fragmentation
• D)Subendocardial granulomatous lesions with fibrinoid necrosis and subsequent fibrosis
• E)Thrombus formation on inflamed valvular endothelium

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