An incidental heart murmur

A 50-year-old patient comes to see you for the first time for a checkup. He has a history of hypertension treated with verapamil. He exercises regularly at the gym and jogs without significant shortness of breath or chest pain and was planning on doing his first half marathon. He has no other cardiac risk factors, but his father died at age 75 of “complications from an enlarged aorta”.

Blood pressure on examination was 150/60. He has a bounding carotid pulse. Cardiac auscultation

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