presents to the emergency department for dyspnea

presents to the emergency department for dyspnea on exertion. He is now 5 years after an orthotopic heart transplant for nonischemic cardiomyopathy, and in general he has done quite well except for one cytomegalovirus reactivation within the first year. He reports that for the past 3 months, he has noticed that with decreasing amounts of exertion, he has been having limiting dyspnea. He is adamant that he is experiencing no chest pain or pressure during these episodes. He has been perfectly compliant with his regimen of tacrolimus (Links to an external site.), mycophenolate (Links to an external site.) mofetil, and low-dose prednisone (Links to an external site.). Echocardiography reveals a normal left ventricular function with normal left ventricular wall thickness. His electrocardiogram shows normal sinus rhythm at a rate of 80 beats/min. Which of the following is the most likely cause his symptoms and why? 1. medication side effect 2. Antibody mediated rejection 3. cellular rejection 4. CAD

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