Sitting Up in Medicine / Internal Medicine — 55yo Man | Cardiology | SMLE Q#11143
SMLE Question #11143
Medicine / Internal Medicine
Cardiology
Objective: OBJ-163
Last updated: February 2026
A 55-year-old man has several months of progressive exertional dyspnea and reduced exercise tolerance. Cardiac examination reveals a high-pitched, blowing early diastolic decrescendo murmur best heard at the left upper sternal border with the patient sitting up and leaning forward; it is louder with expiration. He has bounding peripheral pulses and a wide pulse pressure. Chest radiography shows cardiomegaly, and ECG shows left ventricular hypertrophy. What is the most likely diagnosis?
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