B) Long, late-peaking murmur

This patient has aortic stenosis and is presenting with complaints secondary to this valvular insufficiency. When aortic stenosis is mild, the murmur will peak in mid systole; as the disease becomes more severe, more time is needed to complete systole, and aortic valve closure becomes delayed. Therefore, the murmur peaks later in systole.

Answer choice A: Continuous, machine-like murmur. A continuous, machine-like murmur is present in patent ductus arteriosus, not aortic stenosis.

Answer choice C: Presence of S4, is incorrect. Presence of an S4 is usually consistent with left ventricular hypertrophy and does present in aortic stenosis.

Answer choice D: Short, early peaking murmur, is incorrect. Increased severity of aortic stenosis is indicated by a long, late peaking murmur, not a short, early-peaking one.

Answer choice E: Short time from S2 to opening snap, is incorrect. A short time from S2 to opening snap is indicative of increased disease severity in mitral stenosis.

Key Learning Point

Aortic stenosis presents with a high-pitched, crescendo-decrescendo, ejection murmur heard best at the right sternal border. When aortic stenosis is mild, the murmur will peak in mid systole; as the disease becomes more severe, more time is needed to complete systole, and aortic valve closure becomes delayed, peaking later in systole.