A 38-year-old female presents to the emergency department with the complaints of shortness of breath and fatigue. History reveals the symptoms have been present for several months but have worsened within the past week. Past medical history reveals endocarditis. Medications include appetite suppressants for weight loss for over one year. Physical examination reveals a blowing holosystolic murmur radiating to the axilla, paravertebral fullness from T1-4, and a tender nodule in the 2nd intercostal space on the right adjacent to the sternum.
The most likely diagnosis is?
A. aortic regurgitation
B. aortic stenosis
C. mitral regurgitation
D. mitral valve prolapse
E. renal artery stenosis
The most accurate diagnostic test is?
A. transthoracic echocardiogram
B. transesophageal echocardiogram
C. CT of the chest with contrast
D. PA and lateral radiograph of the chest
E. carotid Doppler