All of the following are features of thyrotoxicosis, except:

CVS FINDINGS IN THYROTOXICOSIS Most common cardiovascular manifestation is sinus tachycardia, often associated with palpitations, occasionally caused by supraventricular tachycardia. Exertional dyspnea. Hyperactive precordium with loud first heart sound, an accentuated pulmonic component of the second heart sound, and a third heart sound. Systolic ejection click. The high cardiac output produces a bounding pulse, widened pulse pressure and an aortic systolic murmur and can lead to worsening of angina or heart failure in the elderly or those with preexisting heart disease. Atrial fibrillation is more common in patients >50 years of age. A systolic scratch, also known as Means-Lerman scratch, is occasionally heard in 2nd left intercoastal space during expiration. Systolic hypertension.