1. A 40-year-old male presents with acute onset shortness of breath, leg swelling, and orthopnea 18.

1. A 40-year-old male presents with acute onset shortness of breath, leg swelling, and orthopnea 18 months after BPD. The patient has lost a significant amount of weight and now has a BMI of 25. There is no history of recent immobilization and he denies any fever or cough. Patient has a normal mood and has no confabulation. Examination reveals a raised jugular venous pulse, pitting pedal edema, presence of S3 gallop, and crepitation in the bases of both lungs. He has no ataxia or no ophthalmoplegia. The EKG is normal, there is no elevation of cardiac enzymes and a D-dimer assay is normal. A cardiologist is consulted and he makes a diagnosis of acute heart failure. A bolus of furosemide makes the patient more comfortable and sublingual nitroglycerin is administered. What is the most likely diagnosis? A. Chromium deficiency B. Selenium deficiency C. Zinc deficiency D. Thiamine deficiency

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