question: Q:A 67-year-old woman comes to the physician because of intermittent chest pain and dizziness on exertion for 6 months. Her pulse is 76/min and blood pressure is 125/82 mm Hg. Cardiac examination shows a grade 3/6, late-peaking, crescendo-decrescendo murmur heard best at the right upper sternal border. An echocardiogram confirms the diagnosis. Three months later, the patient returns to the physician with worsening shortness of breath for 2 weeks. An ECG is shown. Which of the following changes is most likely responsible for this patient's acute exacerbation of symptoms?? 
  {'A': 'Impaired contractility of the left ventricle', 'B': 'Impaired pulmonary artery outflow', 'C': 'Decreased left ventricular preload', 'D': 'Decreased impulse conduction across the AV node', 'E': 'Increased systemic vascular resistance'},