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Severe calcific aortic stenosis — RACP Adult Medicine MCQ

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ModerateCardiologySevere calcific aortic stenosisRACP Adult Medicine

A 79-year-old woman reports exertional dizziness and chest tightness when walking uphill. She has a slow-rising carotid pulse and a late-peaking ejection systolic murmur radiating to the carotids. ECG shows left ventricular hypertrophy. Her haemoglobin and thyroid function are normal. What is the most likely diagnosis?

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Correct answer: D — Severe aortic stenosis

Exertional angina or syncope with a slow-rising pulse and late-peaking murmur radiating to the carotids is typical of severe aortic stenosis. Hypertrophic cardiomyopathy may produce an ejection murmur but usually has dynamic features and a different pulse character. Mitral regurgitation, pulmonary stenosis and atrial septal defect have different murmur locations and associated signs.

Reference: CSANZ position statements; AMH