An obese female with dilated cardiomyopathy secondary to ...



An obese female with dilated cardiomyopathy secondary to myocarditis presents to the office with the complaint of waking nightly with dyspnea approximately 2-3 hours after reclining. She denies chest pain and cough, and she only gets relief by sitting for 30 minutes in a chair. Her medications include furosemide and enalapril. Physical examination reveals a blood pressure of 140/95 mmHg. Her lungs have bibasilar fine end-inspiratory rales. The cardiac apex is laterally displaced with an anterior ventricular heave and a soft S3. Tender points and tissue texture abnormalities are noted along the lower sternal margins bilaterally. 2+ pitting edema is noted on both legs to the knees. The most likely cause of this patient’s nocturnal symptoms is

A) central redistribution of volume

B) intermittent arrhythmia

C) medication noncompliance

D) nocturnal ischemic events

E) nocturnal worsening of ventricular function

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