"The JVP is 5 cm above the sternal angle with the head of bed elevated Suggests possible congestive heart to 50°. Carotid upstrokes are brisk; a bruit is heard over the left carotid failure with possible left carotid oc-

artery. The PMI is diffuse, 3 cm in diameter, palpated at the anterior ax- clusion and mitral regurgitation illary line in the 5th and 6th intercostal spaces. S1 and S2 are soft. S3 present. Harsh 2/6 holosystolic murmur best heard at the apex, radiating to the lower left sternal border (LLSB). No S4 or diastolic murmurs."

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