Leaning Forward At End-expiration in Medicine / Internal Medicine — 50yo Man | Cardiology | SMLE Q#1086
SMLE Question #1086
Medicine / Internal Medicine
Cardiology
Last updated: February 2026
A 50-year-old man has 6 months of progressive exertional dyspnea and fatigue. He has long-standing uncontrolled hypertension. Examination shows a bounding peripheral pulse and a wide pulse pressure. Cardiac auscultation reveals a high-pitched, blowing, early diastolic decrescendo murmur best heard along the left sternal border with the patient leaning forward at end-expiration. A loud sound is heard over the femoral artery during auscultation. What is the most likely diagnosis?
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