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A 50-year-old man has a 10-year history of poorly controlled hypertension. Vital signs are:

Pulse 96/min
Respirations 16/min
Blood pressure
Left arm 226/120 mm Hg
Right arm 218/118 mm Hg

With the patient in the left lateral decubitus position, a late diastolic sound is heard best with the bell at the apex. Which of the following is the most likely explanation for this auscultatory finding?
A) Aortic insufficiency
B) Aortic stenosis
C) Mitral insufficiency
D) Mitral stenosis
E) Opening snap
F) Pulmonic insufficiency
G) Pulmonic stenosis
H) S3
I) S4
J) Tricuspid insufficiency

the answer is A or I?

in case of aortic insufficiency the diastolic sound is not heard at the apex.

then its s4 sound with left ventricular hypertrophy and it is heard in late diastole?

yes, i would go with I) S4

Pressure overload ..S4..in late diastole