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Aortic stenosis causing exertional syncope — MCCQE Part 1 MCQ

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ModerateLoss of Consciousness/SyncopeAortic stenosis causing exertional syncopeMCCQE Part 1

A 78-year-old man collapses while climbing stairs and recovers within one minute. He reports exertional chest tightness and reduced exercise tolerance. Examination reveals a slow-rising carotid pulse and a harsh ejection systolic murmur radiating to the carotids. What is the most likely diagnosis?

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Correct answer: B — Severe aortic stenosis

Exertional syncope, angina symptoms, slow-rising pulse and a systolic murmur radiating to the carotids point to severe aortic stenosis. Vasovagal syncope is usually triggered by prolonged standing, pain or emotion and has a prodrome. Hypertrophic cardiomyopathy may cause exertional syncope but is less consistent with the classic carotid-radiating murmur in this older patient.

Reference: CCS valvular heart disease resources; MCC Objectives—Syncope