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Syncope from aortic stenosis — SCE Acute Medicine MCQ

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HardMedicine in the ElderlySyncope from aortic stenosisSCE Acute Medicine

An 88-year-old man presents after exertional collapse while walking uphill. He has a slow-rising pulse, ejection systolic murmur radiating to the carotids and bibasal crackles. ECG shows left ventricular hypertrophy and troponin is not dynamic. What is the most appropriate investigation?

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Correct answer: B — Urgent transthoracic echocardiography

Exertional syncope with classic signs of aortic stenosis needs urgent echocardiography to assess valve severity and ventricular function. Tilt testing is for selected reflex syncope after structural cardiac disease is considered. Carotid imaging rarely explains transient global loss of consciousness. The pearl is that exertional syncope is a cardiac red flag in older adults.

Reference: NICE NG106; ESC valvular heart disease guideline