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63213 Pathology

A 56-year-old man has experienced increased fatigue and decreased exercise tolerance for the past 2 years. On physical examination, his temperature is 37deg C, pulse is 75/min, respirations are 17/min, and blood pressure is 115/75 mm Hg. On auscultation, diffuse crackles are audible. The abdomen is distended with a fluid wave, and there is bilateral pitting edema to the knees. A chest radiograph shows pulmonary edema, pleural effusions, and marked cardiomegaly. An echocardiogram shows mild tricuspid and mitral regurgitation and reduced right and left ventricular wall motion, with an ejection fraction of 30%. He experiences cerebral, renal, and splenic infarctions over the next year. Chronic use of which of the following substances has most likely produced these findings?

AAcetaminophen
BCocaine
CEthanol
DLisinopril
Pathology
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