USMLE Step 2 - Question 11

A 82 year old male with a history of recent aortic valve replacement, hypertension, and diabetes presents to the emergency department with fevers for 5 days. No chest pains or shortness of breath are present. His medications include lisinopril, hydrochlorothiazide, aspirin, and coumadin. His temperature is 38.4 C, blood pressure is 160/60, heart rate 100, respirations 20, and oxygen saturation 99% on room air. Physical examination reveals normal lung sounds, a II/IV early diastolic decrescendo murmur, and a very soft 1st heart sound.  Laboratory studies reveal a white blood cell count of 15 thousand and an ESR of 110. A portion of his ECG is below. Which of the following is causing his abnormal finding on his ECG?


A. Aortic valve endocarditis

B. Aortic valve regurgitation

C. Aortic valve annular abscess

D. Aortic valve stenosis