Review Question - QID 215015

A 74-year-old man presents to the clinic with 1 month of intermittent chest discomfort. He describes a pressure-like sensation across his chest that only occurs during his morning walks. His symptoms resolve within 5 minutes after he sits down. He denies any symptoms at rest. He has a history of hypertension, hyperlipidemia, diabetes, and peripheral arterial disease. He takes lisinopril, hydrochlorothiazide, rosuvastatin, and metformin. He is a former smoker with a 50 pack-year smoking history. His temperature is 98.2°F (36.8°C), blood pressure is 154/88 mmHg, pulse is 78/min and regular, and respirations are 16/min. Physical exam reveals a well-appearing man with 1+ radial and pedal pulses. Cardiac exam is unremarkable. A resting electrocardiogram (ECG) is shown in Figure A. Which of the following changes is most likely to occur in this patient’s heart during systole?