Question of the Week

For April 26, 2016

A 71-year-old woman presents to the emergency department with acute-onset shortness of breath. She has a history of hypertension but no known cardiac disease.

On examination, she has a respiratory rate of 32 breaths per minute, a heart rate of 110 beats per minute, and a blood pressure of 192/96 mm Hg. Her jugular venous pressure is elevated, but she has no murmurs. She has bibasilar crackles in her lungs. Her lower extremities show symmetrical 1+ edema.

A bedside echocardiogram reveals concentric left ventricular hypertrophy and hyperdynamic wall motion, with an estimated left ventricular ejection fraction of 70%. The patient has no valvular regurgitation, stenosis, or outflow-tract abnormalities.

Which one of the following cardiac conditions is most likely to be the cause of this patient’s dyspnea?

Mitral valve prolapse
Heart failure with preserved ejection fraction
Hypertrophic obstructive cardiomyopathy
Restrictive cardiomyopathy
Chronic constrictive pericarditis