A 53-year-old woman visits her physician with complaints of shortness of breath and fatigue over the last few weeks. Her past medical history includes hypertension for the last 20 years. She takes hydrochlorothiazide and losartan daily. Her mother died at 54 from a stroke, and both of her grandparents suffered from cardiovascular disease. She has a 13 pack-year history and drinks alcohol occasionally. Her blood pressure is 150/120 mm Hg, pulse 95/min, respiratory rate 22/min, temperature 36.7°C (98.1°F). On physical examination, she has bibasilar rales, distended jugular veins, and pitting edema in both lower extremities. Her pulse is irregularly irregular and her apical pulse is displaced laterally. Fundoscopy is best described as ‘copper wiring’ and ‘cotton wool spots’. Which of the following echocardiographic findings will most likely be found in this patient? A. Ejection fraction: 40% with increased left ventricular wall thickness B. Ejection fraction: 60% with normal left ventricular wall thickness C. Ejection fraction: 80% with regurgitant aortic valve D. Ejection fraction: 55% with dilated chambers and thin walls E. Ejection fraction: 65% with rapid early diastolic filling and slow late diastolic filling
