A 66-year-old man comes to the physician for a 6-month history of progressively worsening shortness of breath on exertion and dry cough. He frequently finds himself waking up at night with difficulty breathing. He sits upright by an open window and that makes him feel better. He feels his chest has been “heavier” during the day and that he gets more easily fatigued throughout the day. He notices by the end of the day his ankles seem a bit fuller, where his boots become tighter. He uses chewing tobacco and smokes one-half pack of cigarettes daily. He takes no medications. A chest x-ray is shown.
Which of the following is most likely to be seen in this patient?
A) Diastolic opening snap
B) Increased zona glomerulosa enzyme synthesis
C) Normal pulmonary capillary wedge pressure
D) Preserved ejection fraction
E) Wide complex tachycardia
