A 55-year-old hypeensive patient has a standing BP 190/100 and sitting BP-180/100. He also has irregularly irregular rhythm, double apical impulse, and bilateral basal crepitations. But no murmurs could be auscultated and hea rate could not be determined. What is the likely cause?

Condition Features Left atrial Myxoma More common in a young female with symptoms of myxoma platypnea and low cardiac output since the tumor limits the blood flow into the left ventricle. Mitral regurgitation Ruled out as no murmur was auscultated in the patient Cor pulmonale Ruled out as primary lung disease or findings of RVF are absent LVH Points in or of diagnosis: 1. Hypeension can lead to LVH causing double apical impulse. 2. HTN can lead to diastolic dysfunction and impacts the atria leading to atrial fibrillation and irregular pulse 3. Basal crepitations can be explained by atrial fibrillation. 4. BP changes in standing and supine position are normal (less than equal to 10mm Hg)