Review Question - QID 109538

A 27-year-old woman presents to the emergency department for chest pain and shortness of breath. She was at home on the phone with a friend when her symptoms started. The patient has a past medical history of anxiety, depression, panic attacks, and constipation. Her current medications include fluoxetine, ibuprofen, clonazepam, sodium docusate, and fexofenadine. Her temperature is 99.5°F (37.5°C), blood pressure is 100/65 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 99% on room air. On physical exam, you see an anxious young woman. The pulmonary exam is clear to auscultation bilaterally with good air movement. The neurological exam is within normal limits. A cardiac exam reveals a murmur heard at the apex that decreases when the patient squats. An ECG is obtained as seen in Figure A. Which of the following would also likely be heard on cardiac auscultation?