A 53-Year-Old Man Comes to the Office Due to Difficulty

A 53-year-old man comes to the office due to difficulty breathing and increasing fatigue.  He has shortness of breath at night and has been sleeping in a recliner to help relieve his dyspnea.  Medical history is significant for hypertension and hyperlipidemia.  Two months ago, the patient suffered a myocardial infarction that was not revascularized due to a delay in seeking treatment.  He quit smoking afterward, but had previously smoked a pack of cigarettes daily for 25 years.  On cardiac auscultation, a low-frequency diastolic heart sound is heard shortly after the second heart sound when the patient lies in the left lateral decubitus position.  Cardiac imaging shows hypokinesis of the left ventricular free wall.  Which of the following is most likely to accentuate this patient's abnormal auscultation finding?

A) Amyl nitrite inhalation
B) Furosemide injection
C) Having the patient stand up
D) Listening at end expiration
E) Valsalva strain phase

Correct Answer:

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