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A 52-year-old Hispanic woman presents for an employment physical examination. The patient is a recent immigrant, and she hasn't seen a doctor for fifteen years. She denies chest pain or shortness of breath. She has good exercise tolerance and doesn't have a history of cardiac problems. The blood pressure is 165/70 mm Hg, and heart rate is 72/min. No jugulovenous distention is seen, and carotid bruits are absent. On heart examination, there is a normal S1, a physiologically split S2, a II/VI systolic ejection murmur at the base, and a III/VI diastolic decrescendo murmur at the left sternal border. This diastolic murmur is best heard when the patient holds her breath while sitting or leaning forward. Which of the following is most likely to benefit this patient?

(A) Digoxin
(B) Metoprolol
© Nifedipine
(D) Balloon manipulation
(E) Valve replacement

c.. PHT with graham steel murmur

dd??

E.

dd

this is tricuspid regurgitation we should go for nifedipine

sorry thats pulmonary regurgitation

IS IT AR WITH MVP??

AOR B

hi vanco

ooh my frnd..... he stefan. how was ur exam?

man i missed u too much