A 60-year-old man comes to the physician for a three-day history of worsening productive cough and shortness of breath. He has smoked two packs of cigarettes daily for 45 years. Physical examination shows a point of maximal impulse in the sub-xiphoid space. Blood pressure is 130/80. Which of the following is most likely to be seen in this patient?
Fixed, wide splitting of S2
Holosystolic murmur that increases with inspiration
Increased pulmonary capillary wedge pressure
Paradoxical pulse
To-and-fro murmur
