Clinical VignetteQuestion 1 of 29
Pump Failure Pattern
A 58-year-old man comes to the cardiology clinic because he can no longer climb the stairs to his second-floor apartment without stopping to catch his breath. He says this has been getting worse over the past 6 months, and his wife noticed his ankles have become swollen. He has hypertension and type 2 diabetes mellitus, both controlled with medications for the past 8 years. His temperature is 37.0°C (98.6°F), pulse is 95/min, respirations are 18/min, and blood pressure is 125/80 mm Hg. Physical examination shows jugular venous distension to 10 cm and bilateral pitting edema extending to the mid-calf. Cardiac examination shows the point of maximal impulse displaced laterally; S1 and S2 are present with an S3 gallop. Crackles are heard at both lung bases. Transthoracic echocardiography shows a left ventricular end-diastolic dimension of 6.8 cm, posterior wall thickness of 8 mm, and an ejection fraction of 25%. There is global hypokinesis with all myocardial segments uniformly affected. Coronary angiography reveals no significant stenosis in any vessel.
Which of the following is the most likely diagnosis?