A 64-Year-Old Man Presents to the Office with Chest Discomfort and Mild

A 64-year-old man presents to the office with chest discomfort and mild shortness of breath that started one hour ago after an argument with his wife.  He has a long history of hypertension and diabetes mellitus.  His blood pressure is 180/100 mmHg and his heart rate is 100/min.  An EKG taken in the emergency department shows no signs of acute ischemia.  Cardiac auscultation in the left decubitus position on full expiration reveals a presystolic sound.  Which of the following best explains this physical examination finding?

A) Papillary muscle dysfunction
B) Left ventricular hypertrophy
C) Increased left ventricular preload
D) Aortic regurgitation
E) Mitral leaflet fusion and fibrosis

Correct Answer:

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