This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Hea Sounds, Subject name: Medicine
A 60 year old marathon runner complains of dizziness episodes. On auscultation ejection systolic murmur is heard. ECG is done. Clinical diagnosis is? 
Select and explain. 
A. HTN with Atrial fibrillation, B. LVH with Valvular Aoic stenosis, C. RVH with Valvular Pulmonic stenosis, D. Brugada Syndrome
B: LVH with Valvular Aoic stenosis
Answer: B: LVH with Valvular Aoic stenosis 
Explanation: The ECG shows hea rate of 50/min with left axis. Patient is in normal sinus rhythm. QRS duration is normal. T wave inversion is noted in lead I, aVL and V5-V6 indicating possible ischemic changes. Depth of S wave in V1 =20mm Height of R wave in V5= 30mm SV1 + RV5/6(tallest R in either V5 or V6) >35 mm is diagnostic of Left ventricular hyperophy( Sokolov- Lyon criteria) The low hea rate is explained by high vagal tone seen in marathon runners.