30-year-old Man in Medicine / Internal Medicine — 30yo Man | Cardiology | SMLE Q#1133
SMLE Question #1133
Medicine / Internal Medicine
Cardiology
Last updated: February 2026
A 30-year-old man has 2 weeks of progressive dyspnea on exertion, paroxysmal nocturnal dyspnea, and orthopnea. He reports intermittent left-sided chest discomfort. Examination shows a displaced diffuse apical impulse, bibasilar crackles, an S3, and a high-pitched holosystolic murmur at the apex radiating to the axilla. He has no previous cardiac disease. What is the most appropriate next step in management to establish the diagnosis and guide therapy?
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