A 48-Year-Old Man Comes to the Office Due to Progressive

A 48-year-old man comes to the office due to progressive exertional dyspnea.  It has become especially bothersome over the past 2 months.  He now becomes short of breath after climbing one flight of stairs.  He has no known medical problems.  He is not taking any medications and does not use tobacco or alcohol.  Temperature is 37.2 C (98.9 F) , blood pressure is 130/75 mm Hg, pulse is 78/min, and respirations are 14/min.  Chest examination reveals a harsh systolic murmur that is best heard at the right second intercostal space with radiation along the carotid arteries.  An S4 is heard at the apex.  Based on these findings, what is the most likely cause of this patient's symptoms?

A) Hypertrophic cardiomyopathy
B) Myxomatous valve degeneration
C) Rheumatic heart disease
D) Bicuspid aortic valve
E) Senile calcific aortic stenosis

Correct Answer:

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