A 72-Year-Old Man Comes to the Office Due to Palpitations

A 72-year-old man comes to the office due to palpitations and mild fatigue for the last 3 weeks.  He has otherwise been feeling well.  The patient walks 2 miles around his neighborhood twice per week with no chest pain or shortness of breath.  Medical history is remarkable for benign prostatic hyperplasia, for which he takes terazosin.  He drinks 1-2 cups of coffee every day and a glass of wine once or twice per month.  Temperature is 37 C (98.6 F) , blood pressure is 128/68 mm Hg, and pulse is 78/min and irregular.  Physical examination reveals a 2/6 early-peaking systolic murmur at the right upper sternal border.  Carotid pulses are prompt and full bilaterally.  The lungs are clear to auscultation.  There is no peripheral edema.  ECG is shown in the exhibit.  Which of the following is most likely the strongest risk factor for this patient's presentation?

A) Advanced age
B) Alcohol use
C) Aortic stenosis
D) Coffee consumption
E) Terazosin use

Correct Answer:

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