Medical Mystery of the Week

This 42-year-old caucasian man presents with a history of syncope during exercise. He has also noted fatigue and mild dyspnea on exertion for the past year. He has otherwise been healthy, with no history of angina, hypertension, or diabetes mellitus. On physical exam, you note cardiomegaly, a triple apical impulse, a rapidly rising carotid artery pulse, and a murmur which was loudest along the left sternal border and at the cardiac apex (video). What is your diagnosis and how would you confirm your diagnosis at the bedside?

chest x-ray 

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