Quiz 26 Context:
A 47-year-old male presents for follow-up. Six months ago the patient suffered from an acute apical transmural myocardial infarction complicated by a gastrointestinal bleed. The patient did not receive thrombolytics due to the GI bleeding. Cardiac catheterization after the infarction did not suggest other areas of critical narrowing. Subsequently the patient underwent medical treatment and was released. Over the past week he has noticed increasing dyspnea and orthopnea.The patient reports a past history of hypertension, and diabetes. Medications now include insulin, aspirin, a B-blocker, and a statin. He does not smoke or drink alcohol.
Physical examination reveals a male patient in no acute distress. Vital signs reveal a temperature of 37.2 degrees Celsius, heart rate 74 bpm, blood pressure 120/72 mmHg. The exam is most notable for a suggestion of cardiac enlargement, a diffuse apical impulse that is displaced to the left of the midclavicular line, a third heart sound, and a systolic murmur thought to be consistent with mitral regurgitation. As part of the evaluation, an EKG and chest X-ray are done.
The key findings of these studies are shown above.
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This history, examination, and data are most consistent with which of the following possibilities as a cause for the symptoms: