A 70-year-old male presents with exertional syncope, angina, and dyspnea. Physical examination reveals a late-peaking harsh crescendo-decrescendo systolic murmur at the right upper sternal border that radiates to the carotid arteries, with diminished and delayed carotid pulses (pulsus parvus et tardus). What is the underlying pathology?

Answer and explanation

Correct answer: A. Severe Aortic Stenosis

  1. Step 1: The classic triad of aortic stenosis symptoms is angina, syncope, and heart failure (exertional dyspnea).
  2. Step 2: Physical findings of a harsh crescendo-decrescendo systolic ejection murmur radiating to the carotids combined with delayed, weak carotid pulses (pulsus parvus et tardus) are pathognomonic for severe aortic stenosis.
Answer
Severe Aortic Stenosis.
Why not the others: 'Mitral Valve Prolapse' produces a mid-systolic click followed by a late systolic murmur loudest at the apex; 'Tricuspid Regurgitation' produces a holosystolic murmur at the left lower sternal border that increases with inspiration (Carvallo's sign); 'Hypertrophic Cardiomyopathy' produces a systolic murmur that intensifies with Valsalva maneuver and decreases with squatting.

Practise more Cardiovascular and Respiratory Medicine.

Free questions with an explanation for every one, and full timed DHA Dubai mock tests.

All Cardiovascular and Respiratory Medicine questionsTake a mock test

More Cardiovascular and Respiratory Medicine questions