A 44-Year-Old Man with a History of Intravenous Drug Use

question 27

Multiple Choice

A 44-year-old man with a history of intravenous drug use came to the emergency department due to fever and chills.  Multiple blood culture sets were positive for Staphylococcus aureus, and the patient was diagnosed with infective endocarditis.  He was successfully treated with a long course of antibiotics.  Six months later, he returns to the clinic for a follow-up evaluation.  The patient has no symptoms and reports good exercise tolerance.  He is afebrile, blood pressure is 140/62 mm Hg, pulse is 82/min, and respirations are 16/min.  Chest auscultation reveals a decrescendo diastolic murmur over the third intercostal space along the left sternal border.  Echocardiogram shows severe aortic regurgitation, likely as a sequela to the prior infection.  Which of the following changes is most responsible for maintaining cardiac output in the setting of this valvular abnormality?

• A)Concentric left ventricular hypertrophy
• B)Decrease in left ventricular preload
• C)Increase in aortic elasticity
• D)Increase in left ventricular afterload
• E)Increase in left ventricular stroke volume
• F)Sustained increase in heart rate

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