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Aortic stenosis — MCCQE Part 1 MCQ

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HardLoss of Consciousness/SyncopeAortic stenosisMCCQE Part 1

A 71-year-old man has three episodes of exertional syncope over 2 months. He reports chest tightness when climbing stairs. Examination shows a slow-rising carotid pulse and a harsh ejection systolic murmur at the right upper sternal border radiating to the carotids. What is the most appropriate investigation?

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Correct answer: B — Transthoracic echocardiography

Syncope with an ejection systolic murmur radiating to the carotids suggests severe aortic stenosis, and echocardiography is the key investigation to confirm severity and ventricular function. Exercise testing may be hazardous before defining severe symptomatic valve disease. CT brain would not address the exertional cardiac syndrome. D-dimer is not relevant without a thromboembolic presentation.

Reference: CCS valvular heart disease guidance