A 68-year-old man comes to the emergency department because of a 1-week history of difficulty breathing

A 68-year-old man comes to the emergency department because of a 1-week history of difficulty breathing. He has had recurrent palpitations over the past 2 years. During this time, he has also had several episodes of anxiety despite no change in his daily life. He has occasional sharp chest pain localized to the left upper sternal border. He has no abdominal pain or leg swelling. Two years ago, he had streptococcal pharyngitis, which was promptly treated with a 10-day course of penicillin. He has never traveled outside of the country, His temperature is 36.5°C (97.7° F), pulse is 82/min, and blood pressure is 140/85 mm Hg. Physical examination shows a 316 holosystolic murmur that is loudest at the apex and radiates to the loft axilla preceded by a mid-systolic click. Bl. crackles are heard on lung auscultation. What is the most likely etiology of the patient’s cardiovascular disorder? Answers A-E A Myxomatous valve degeneration B Overproduction of catecholamines C Ectopic production of serotonin D Inflammatory valve degeneration O E Calcific valve degeneration