A 70-Year-Old Man Comes to the Clinic for Routine Follow

A 70-year-old man comes to the clinic for routine follow up. He has a long term hypertension and diabetes mellitus. He states that he often feels shortness of breath after a mild exertion. His blood pressure is 150/80 mmHg and his heart rate is 85/min. An EKG reveals no ischemic finding. During chest auscultation in the left decubitus position on full expiration reveals a presystolic sound. Which of the following best explains this physical examination finding?

A) Papillary muscle dysfunction
B) Left ventricular hypertrophy
C) Increased left ventricular preload
D) Aortic regurgitation
E) Mitral leaflet fusion and fibros