A 31-Year-Old Man Is Evaluated for a Murmur

A 31-year-old man is evaluated for a murmur.  He has no other symptoms and his past medical history is unremarkable.  He jogs 3 times per week and rides a bicycle on the weekend.  His blood pressure is 122/70 mm Hg on the right arm and 125/75 mm Hg in both ankles.  On physical examination, a harsh, 4/6 holosystolic murmur is heard at the 4th left intercostal space close to the sternal border accompanied by a thrill.  The rest of the physical examination is within normal limits.  Which of the following is the most likely diagnosis?

A) Atrial septal defect
B) Mitral valve prolapse
C) Tetralogy of Fallot
D) Tricuspid valve stenosis
E) Ventricular septal defect

Correct Answer:

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