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MKSAP 19 Q & A
An 18-year-old man is evaluated for a heart murmur noted on a preparticipation sports examination. He remembers being told about a murmur in the past, but he has had no prior testing or intervention. He is asymptomatic, without known medical problems, and takes no medications.
On physical examination, vital signs are normal. The estimated central venous pressure is normal. Apical impulse is normal, and a thrill is noted along the left sternal border. A grade 4/6 holosystolic murmur is heard at the left sternal border, obscuring the S2. The remainder of the physical examination is unremarkable.
An ECG and chest radiograph are normal.
Which of the following is the most likely diagnosis?
A: Atrial septal defect
B: Coarctation of the aorta
C: Patent ductus arteriosus
D: Ventricular septal defect
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