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Pathology 26

A 75-year-old man with a history of hypertension and type 2 diabetes presents to the emergency department with a complaint of dyspnea and shortness of breath after exercise for the past few weeks. The patient notes that he generally stays active and does not live a sedentary lifestyle. He denies nausea, vomiting, fevers, and chills. He drinks alcohol socially and smokes 3-4 cigarettes daily. Current medications include amlodipine and metformin. Vital signs in the emergency department are temperature 36°C (98.6°F), blood pressure 134/84 mmHg, pulse 75 beats/min, and respirations 17/min. Body mass index (BMI) is 30 kg/m2. Physical examination reveals a high-pitched, crescendo-decrescendo, midsystolic ejection murmur at the right sternal border. All lung fields are clear to auscultation. Laboratory values are within normal limits.

Which of the following most reflects increased severity of this patient’s condition?

  • A) Continuous, machine-like murmur
  • B) Long, late-peaking murmur
  • C) Presence of S4
  • D) Short, early peaking murmur
  • E) Short time from S2 to opening snap


Ria Patel


Dr. Ted O'Connell

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