Which murmur would be suspected in a patient presenting with angina after a syncopal episode and auscultating S4?

Aortic stenosis is a likely murmur to suspect in this scenario due to the specific symptoms and auscultation findings presented. Patients with aortic stenosis often experience a triad of symptoms: exertional dyspnea, angina, and syncope. The fact that the patient is experiencing angina after a syncopal episode fits well with the symptomatology of aortic stenosis, particularly since the condition leads to decreased blood flow and increased oxygen demand during exertion.

The presence of an S4 heart sound, which is indicative of left ventricular hypertrophy or decreased ventricular compliance, further supports the possibility of aortic stenosis. In this condition, the left ventricle works harder to eject blood through the narrowed aortic valve, leading to hypertrophy over time. The S4 sound is often associated with conditions where the left ventricle is stiff and struggles to fill, which can occur in the presence of aortic stenosis.

In contrast, other murmurs such as mitral regurgitation, mitral valve prolapse, or mitral stenosis do not typically correlate with the combination of angina following syncope and the presence of an S4 heart sound as strongly as aortic stenosis does. Mitral reg