A 65 year-old man complains of progressive shortness of breath for 6 months. He smokes a pack of cigarette daily for 50 years. He drinks 3-4 beers daily for 40 years. Otherwise, he has a healthy life style. On examination, the point of maximum impulse is displaced and rales are heard on both lung bases. He also has hepatosplenomegaly. His echo show both right and left ventricular dilation and low ejection fraction. His lab tests are as follows: AST: 240 U/L ALT: 130 U/L Alkaline phosphatase 230 U/L What is the most likely cause of his cardiac findings? A- Smoking B- Chronic alcohol intake C- Rheumatic heart disease D- Chronic hypertension http://medical-usmle.com/?p=839
