Question:
A 68-year-old man, whose medical history is significant for hypertension and diabetes mellitus type II, was admitted for constant substernal chest pressure and exertional dyspnea associated with orthopnea and bilateral lower extremity edema for one week. His exam was remarkable for elevated jugular venous pressure, a holosystolic murmur at the left lower sternal border radiating toward the apex, and 2+ pitting edema in bilateral lower extremities. Electrocardiogram (EKG) showed Right bundle branch block with T wave inversions in inferior and anterolateral leads without a prior EKG for comparison. Serial troponin levels were negative and the brain-natriuretic peptide level was elevated (535 pg/mL). Chest radiograph showed cardiomegaly and interstitial edema.