A 64-year-old woman presents to the emergency room complaining of shortness of breath, fatigue, palpitations and chest pain. She is not able to lie down on her bed because it makes her shortness of breath worse. On physical examination, you note that she has a holosystolic, high-pitched, blowing murmur with a midsystolic click heard best at the apex with radiation to the axilla. When you used some bedside maneuvers, the murmur decreased in intensity with Valsalva and standing and increased in intensity with handgrip. Which of the following is the most likely diagnosis in this patient?

A 24-year-old man presents to the emergency room with acute chest pain and a nonproductive cough for the last 3 days. The chest pain increases with inspiration, ‘it is always there’, it is ‘bearable’ and sometimes moves to his neck and back. In review of systems, he reports that the chest pain gets worse with lying flat and improves by sitting up. His medical history is significant for Covid-19 infection ten days ago. He attends a local university and is a member of the athletic team. His temperature is 101 ⁰ F, heart rate is 62 beats per minute, respiratory rate is 12 breaths per minute, and blood pressure is 110/80 mm Hg. Physical examination is significant for a friction rub. No lymphadenopathy, no skin rashes, no oral abnormalities noted. ECG reveals diffuse upsloping ST segment elevation and PR segment elevation in lead aVR and PR segment depression in other leads.No pathologic Q waves or reciprocal changes are present .Laboratory tests reveal elevated troponin and C reactive protein. Chest x-ray is normal. Echocardiogram is normal. Which of the following is the most likely diagnosis in this patient?

A 38-year-old male comes to the emergency room complaining of shortness of breath on exertion for a few weeks. His medical history is significant for malignant melanoma. Physical examination is significant for dyspnea, jugular venous distention, pericardial friction rub,muffled cardiac tones, and hypotension. ECG shows low-voltage electrical waves. You suspected pericardial tamponade in this patient and wanted to do a bed-side maneuver to establish the diagnosis. Of the following, the measurement of which would help you in reaching the correct diagnosis in this patient?

A 43 year-old man presents to the emergency department complaining of weakness, feeling bad, and difficulty breathing for the last 4 days. His temperature is normal, heart rate is 160 beats per minute, blood pressure is 60/40 mm Hg, and oxygen saturation is 91% on 80% FiO2 by face mask.On physical examination, his trachea is not deviated. His lung sounds are normal. But his heart sounds are muffled, distant and faint. You noted swollen veins in the neck with pressure not changing with breathing. There is an abnormal drop in systolic blood pressure when he inhales and the disappearance of radial pulse on inspiration. ECG revealed a QRS complex height that varies from one heart beat to the next. On chest x-ray, the cardiac silhouette is rounded in its lower portion and ­tapers at the base of the heart resembling a plastic bag filled with water sitting on a table. Jugular venous pressure waveform is remarkable for prominent x descent and absent y descent. Laboratory tests revealed normal troponin levels. Echocardiogram revealed a small right ventricle and confirmed the suspected diagnosis. Which of the following is most likely to be diagnosed in this patient?

A 68-year-old woman presents to your office complaining of shortness of breath. She reports that over the last two months, she has become progressively short of breath with activity. She feels dizzy when she walks faster; her abdomen feels distended; and her legs feel swollen. Her temperature is 98 °F, heart rate is 56 beats/min, blood pressure is 110/84 mm Hg, respirations are 19 breaths/min, and oxygen saturation is 94% on room air. Physical examination is notable for bilateral crackles in the lung fields and pitting edema in bilateral lower extremities. You ordered an ECG, which shows the right bundle branch block with low voltage QRS complexes. Later your order an echocardiogram which revealed a concentric thickening of the left ventricle; relative apical-sparing or “cherry-on-top” pattern on a longitudinal strain bull’s eye display with bright myocardium. Laboratory tests revealed elevated troponin. Abdominal fat biopsy shows apple-green birefringence with Congo red staining. Of the following, which is the most likely diagnosis in this patient?

A 22-year-old college wrestler comes for a sports physical examination. He tells you that he often feels excessively short of breath during practice and even has had chest pain that resolves with rest. He reports experiencing a syncopal episode 3 months ago while running a marathon. While taking the family history he tells you that his father died of ‘earlier-than-normal age’ sudden death. You send the patient for an echocardiogram, which reveals a hypertrophic heart, a thickened interventricular septum and a functional left ventricular outflow obstruction durings systole. You suspect hypertrophic obstructive cardiomyopathy in this young man. Of the following, where would you expect to hear the murmur with the loudest intensity?