USMLE Step 1 - Question 48

A 55 year old male complains of increasing dyspnea on exertion and orthopnea. His physical examination reveals an S3 heart sound, pulmonary rales, jugular venous distension, and lower extremity edema. Coronary angiography is normal. An echocardiogram confirms an ejection fraction of 5% indicating severe congestive heart failure and dilated cardiomyopathy. Which of the following could explain the above findings?

A. A history of heroin abuse

B. Heavy alcohol use

C. Tuberculosis infection

D. Prior chemotherapy with cisplatin