A 37-year-old female presents to the office complaining of ...



A 37-year-old female presents to the office with a three-week history of fatigue, palpitations, dyspnea on exertion, and fever. She reports that she returned from a trip to South America one month ago. She admits to a history of cocaine and alcohol abuse. Vital signs reveal a temperature of 37.0°C (98.6°F), a heart rate of 116/min, and a respiratory rate of 20/min. Auscultation of the lungs reveals bibasilar rales but no wheezes. Cardiac examination reveals an S3, an S4, and a grade 2/4 high-frequency systolic murmur at the apex with radiation to the axilla. Physical examination reveals tissue texture abnormalities at T1-T5 and minimal bilateral pedal edema. ECG is significant for sinus tachycardia, diffuse ST-segment depression, and a left bundle branch block. A chest radiograph reveals cardiomegaly, and an echocardiogram shows dilated and hypokinetic chambers. The most likely diagnosis is

A) acute myocardial infarction

B) endomyocardial fibrosis

C) inflammatory pericarditis

D) myocarditis

E) pulmonary embolism

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