An 80-year-old male presents with exertional syncope and angina. Auscultation reveals a late-peaking systolic murmur radiating to the carotids with pulsus parvus et tardus. What is the diagnosis?

Answer and explanation

Correct answer: D. Severe aortic stenosis

  1. Step 1: The classic symptomatic triad of severe aortic stenosis is exertional angina, syncope, and heart failure symptoms.
  2. Step 2: Physical examination findings of a delayed, diminished carotid pulse (pulsus parvus et tardus) and a harsh systolic ejection murmur radiating to the neck confirm severe aortic stenosis.
Answer
Severe aortic stenosis.
Why not the others: Mitral valve prolapse presents with a mid-systolic click and late systolic murmur without delayed carotid pulses. Tricuspid regurgitation produces a holosystolic murmur at the left lower sternal border that increases with inspiration. Pulmonic stenosis is a rare congenital lesion causing a systolic murmur at the left upper sternal border without carotid radiation.

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