Question

A 72-year-old man with a past medical history of hyperlipidemia, inferior wall myocardial infarction 6 months ago, and congestive heart failure has presented to his local medical office with complaints of increased tiredness and fatigue upon ambulation over the past several weeks. He denies edema, syncope, lightheadedness, dizziness, chest pain, palpitations, cough, shortness of breath, abdominal pain, fever, or chills. An EKG was performed, which revealed a first degree AV block.

What is the most likely physical exam finding expected in this patient?
1 Increased intensity of S1 heart sound
2 An irregular cardiac rhythm
3 Systolic murmur decreased with squatting
4 Delayed carotid upstrokes
5 Blowing apical diastolic murmur

Answer 1

The most likely physical exam finding for a 72-year-old man with a first degree AV block and a history of heart issues is delayed carotid upstrokes, which are related to his left ventricular systolic dysfunction.

Step-by-step explanation:

The most likely physical exam finding in a 72-year-old man with a first degree AV block and a history of congestive heart failure, hyperlipidemia, and myocardial infarction is delayed carotid upstrokes. Considering his history, it doesn't seem that he exhibits symptoms of volume overload such as edema, or systolic dysfunction as indicated by syncope, palpitations, or chest pain. Delayed carotid upstrokes can be associated with left ventricular systolic dysfunction as a result of his past myocardial infarction and congestive heart failure.

In comparison, none of the other options given, like increased intensity of the S1 heart sound, an irregular cardiac rhythm, systolic murmur decreased with squatting, or blowing apical diastolic murmur, are typically associated with first degree AV block. First degree AV block often doesn't result in any physical exam changes, but in the context of this patient's history, a subtle sign such as delayed carotid upstrokes related to left ventricular systolic dysfunction might be the most likely finding.