A 52-Year-Old Man Comes to the Office Due to a 2-Week

A 52-year-old man comes to the office due to a 2-week history of progressive fatigue and exertional dyspnea.  The patient is a postal delivery worker and reports that he gets short of breath after walking a few blocks.  He has not had chest pain or palpitations.  The patient does not use tobacco, alcohol, or illicit drugs.  Cardiac auscultation reveals a murmur that is best heard when the patient sits up and leans forward.  He brings to the office the report from a recent cardiac catheterization (graph shown below) .  This patient's murmur would most likely be loudest at which of the following time points on the graph?

A) A
B) B
C) C
D) D
E) E

Correct Answer:

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