A 62-Year-Old Man with a Long History of Hypertension Comes

A 62-year-old man with a long history of hypertension comes to the clinic for a routine physical examination.  Blood pressure is 150/90 mm Hg and pulse is 74/min and regular.  Cardiac auscultation reveals a low-frequency, presystolic sound that immediately precedes S1 and is best heard during expiration when the patient is lying on his left side.  Chest x-ray reveals extensive calcification around the mitral and aortic valves.  Which of the following is the most likely explanation for the additional heart sound?

A) Increased flow velocity through the aortic valve
B) Increased stiffness of the left ventricular wall
C) Rapid passive filling of the ventricles
D) Restricted motion of the aortic valve cusps
E) Systolic anterior motion of the mitral valve

Correct Answer:

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