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Severe aortic stenosis — RCPSC IM MCQ

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HardCardiologySevere aortic stenosisRCPSC IM

A 79-year-old has exertional syncope, angina, a late-peaking systolic murmur radiating to the carotids and a soft second heart sound. What investigation should be obtained first?

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Correct answer: A — Perform transthoracic echocardiography with Doppler

The best answer is “Perform transthoracic echocardiography with Doppler”. The presentation suggests severe aortic stenosis, and echocardiography defines valve anatomy, gradients, valve area and ventricular response. Exercise testing before severity is known can be unsafe in a symptomatic patient; the other tests do not quantify valve obstruction.

Reference: CCS/CHFS HFrEF guideline update, PubMed record: https://pubmed.ncbi.nlm.nih.gov/33827756/