Question of the Week

For September 17, 2019

An 81-year-old man with hypertension reports slight dyspnea and chest tightness when walking uphill or climbing stairs during the past year. His blood pressure has been well controlled on hydrochlorothiazide and enalapril.

On physical examination, a harsh grade 3/6 crescendo–decrescendo murmur, typical of aortic stenosis, is heard maximally at the upper right sternal border. His lungs are clear to auscultation, and he has no peripheral edema.

Which one of the following additional physical findings is most consistent with a diagnosis of severe aortic stenosis?

A bounding carotid pulse
A soft or absent aortic component of the second heart sound
Radiation of the murmur to the neck
Presence of a fourth heart sound
A loud aortic component of the second heart sound