A 67-year-old woman with a history of hypertension treated with an angiotensin-converting enzyme inhibitor and β-blocker presents to her primary care physician for a routine physical examination. She has no complaints. Her blood pressure is normal, and the rest of her physical examination is unremarkable except for a grade II/IV harsh early peaking systolic ejection murmur at the second intercostal space. It radiates to her neck. Her carotid pulses are normal. Her pulse is noted to be irregular, and an ECG is obtained.
What is the diagnosis?
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