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Aortic stenosis with syncope — SCE Acute Medicine MCQ

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ModerateAcute Cardiac PresentationsAortic stenosis with syncopeSCE Acute Medicine

A 82-year-old man is assessed on the acute medical unit. He collapses while walking uphill. Examination shows a slow-rising pulse and a harsh ejection systolic murmur radiating to the carotids. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most likely diagnosis?

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Correct answer: A — Severe aortic stenosis

Severe aortic stenosis is the best answer because exertional syncope with classic murmur and pulse character suggests severe aortic stenosis. Acute pulmonary oedema with acidaemia is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Vasodilators and aggressive diuresis can be poorly tolerated in fixed outflow obstruction.

Reference: https://www.nice.org.uk/guidance#acute-medicine-order-45-1