HPI: AB is a 76-year-old Asian man who presents with new-onset syncope. He denies palpitations or angina but experiences dyspnea with mild exertion and early fatigue. His past medical history is...

HPI: AB is a 76-year-old Asian man who presents with new-onset syncope. He denies palpitations or angina but experiences dyspnea with mild exertion and early fatigue. His past medical history is notable for diabetes, HTN, and a severe childhood febrile illness with associated sore throat. AB has also experienced a persistent cardiac murmur since the childhood illness.

PE: Vitals: Temperature (T) 37.0°C; HR 70 beats/min; BP 160/80 mm Hg; RR 16 breaths/min, JVP 7 cm with slow carotid upstroke and decreased carotid volume. Chest: Clear to auscultation. Cardiac: Sustained enlarged PMI with late-peaking 4/6 systolic murmur at right sternal border radiating into the neck and single second heart sound. Opening snap (OS) present after S2 with a 2/4 diastolic decrescendo murmur. Extremities: No edema. CXR: Mild cardiomegaly. ECG: Normal sinus rhythm with LV hypertrophy.