USMLE Question: Clinical Case - 08

A forty five year old man complains of discomfort in his throat and upper chest. This discomfort sometimes comes when he takes a heavy meal. More often he experiences it when he walks up a hill to visit his parents. He has no other symptoms and is not on any regular medication. On examination he looks well. His pulse is of low volume and the pulse rate is 68/minute. BP is 110/80 mm of Hg. He is not anemic clinically and is afebrile. Examination of cardio-vascular system reveals a systolic murmur best audible at third inter-coastal space on the left sternal border and is radiating to carotids. Respiratory examination was normal, There was no crepitations, wheezing or decreased breath sounds. He had raised LDL(Low density cholesterol) cholesterol and Low HDL (High density Cholesterol)

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