A 71-Year-Old Man Comes to the Office Due to a 2-Month

A 71-year-old man comes to the office due to a 2-month history of progressive exertional dyspnea.  The patient is unable to walk half a block without resting and can no longer climb stairs without stopping every few steps.  He also has had difficulty sleeping due to repeatedly waking up at night feeling like he is suffocating.  Physical examination shows bilateral lower extremity edema and distended neck veins.  Cardiac auscultation findings over the apex are given below.  This patient's auscultatory findings most likely reflect which of the following?

A) Aortic valve sclerosis
B) Bulging of the interventricular septum
C) Dynamic left ventricular outflow obstruction
D) Elevated pulmonary arterial pressure
E) Increased left ventricular end-systolic volume

Correct Answer:

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