65 year old man experienced fainting episode with exertion. - Diagnosis

Patient Chart History: Patient experienced fainting episode while carrying heavy boxes. Has also noticed abdominal bloating over the course of last six months.

Physical Exam
Shows clubbing of the nail bed and swollen ankles.
Resting pulse rate of 65 beats per minute.

Test Results: CVC and platelet count normal.
Urinalisis normal
Elevated fasting blood sugar.

Heart Sounds:

Diagnosis What is your diagnosis?

Case #234