For the past 2 years, a 56-year-old man has experienced increased fatigue and decreased exercise tolerance....

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For the past 2 years, a 56-year-old man has experienced increased fatigue and decreased exercise tolerance. Onphysical examination, his temperature is 36.9°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 dis tended 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 is most likely to produce these findings? (A) Acetaminophen (B) Cocaine (C) Digoxin (D) Ethanol (E) Lisinopril (F) Nicotine (G) Propranolol For the past 2 years, a 56-year-old man has experienced increased fatigue and decreased exercise tolerance. Onphysical examination, his temperature is 36.9°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 dis tended 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 is most likely to produce these findings? (A) Acetaminophen (B) Cocaine (C) Digoxin (D) Ethanol (E) Lisinopril (F) Nicotine (G) Propranolol

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