USMLE Step 1 - Question 39

A 84 year old male with a history of severe emphysema and a prior myocardial infarction becomes short of breath with exertion. Physical examination reveals a III/VI holosystolic murmur at the cardiac apex, an S3 heart sound, and rales in the lower lung fields. No lower extremity edema is present. Which of the following is the likely diagnosis?

A. Left-sided congestive heart failure

B. Right-sided congestive heart failure

C. Left and right sided congestive heart failure

D. Cor pulmonale