A 60-Year-Old Man Comes to the Office Due to Several

A 60-year-old man comes to the office due to several episodes of lightheadedness over the last 3 months.  He experiences these episodes while trying to walk quickly or climb stairs.  He "almost passed out" during the last episode.  The patient describes his lifestyle as active but recently has felt more tired than usual during his daily activities.  He has had no chest pain or palpitations.  Medical history is significant for diverticulosis, for which he takes fiber supplements.  The patient is on no other medications.  Temperature is 37.1 C (98.8 F) , blood pressure is 108/92 mm Hg, pulse is 88/min and regular, and respirations are 14/min.  On examination, he has a 3/6 systolic murmur that is best heard over the right upper sternal border.  Carotid pulses are slow-rising and delayed bilaterally.  The lung fields are clear to auscultation.  There is no peripheral edema.  Which of the following additional findings is most likely to be seen on physical examination?

A) Apical mid-diastolic murmur
B) Audible S3
C) Early-peaking systolic murmur
D) Loud S1
E) Soft and single S2 during inspiration

Correct Answer:

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