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Physiology
A 65-year-old man presents to his primary care physician complaining of dyspnea, chest pain, and several syncopal episodes. His symptoms have worsened over the past few months and his third syncopal episode prompted this visit. On examination, a systolic ejection murmur is auscultated with an ejection click in the right second intercostal space. Rales are present at the lung bases. He has a history of rheumatic fever in his twenties. Which of the following might explain the angina pectoris in this patient?
Increased ventricular wall tension limits perfusion
Left ventricular hyperophy accelerates atherosclerotic disease
Pulmonary hypeension decreases the PO2 of aerial blood
Stenotic valves occlude the coronary aeries
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