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Cardiology MCQ

 Question:

A 70-year-old man presents with exertional dyspnea, chest pain, and syncope. On examination, there is a crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotids, and delayed carotid upstroke. What is the most likely diagnosis?

Options:

A. Mitral regurgitation

B. Aortic regurgitation

C. Aortic stenosis

D. Pulmonic stenosis

✅ Answer: C. Aortic stenosis



Explanation:

Classic triad of aortic stenosis:

Exertional dyspnea (most common presenting symptom due to LV hypertrophy and diastolic dysfunction).

Angina (due to increased myocardial oxygen demand).

Syncope (especially on exertion, due to fixed cardiac output).


Physical exam findings:

Systolic ejection murmur: Crescendo-decrescendo, best heard at the right upper sternal border, radiates to the carotids.

Delayed and diminished carotid upstroke: “Pulsus parvus et tardus”.

LV heave may be present due to left ventricular hypertrophy.


Pathophysiology:

Progressive calcification of the aortic valve → obstruction to LV outflow → LVH → eventual heart failure if untreated.


Management:

Symptomatic severe AS → aortic valve replacement (surgical or TAVR).

Medical therapy: primarily for symptom control; does not replace valve intervention.


References: 

Harrison’s Principles of Internal Medicine, 21st Edition, Ch. 224; 

Braunwald’s Heart Disease, 12th Edition, Ch. 53; 

UpToDate: Aortic stenosis in adults.

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