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Question

73yo man, with a history of hypertension and coronary disease, is brought into the emergency room after a witnessed syncopal episode at home. He reported some mild exertional chest pain over the past few days, but states that it improved with rest. Vital signs are BP-180/98, HR-74, RR-12, and O2-100%. He is currently in no distress and not diaphoretic. Physical examination revealed a systolic murmur over the 2nd right intercostal space. A CT was ordered to rule-out PTE in the setting of chest pain and syncope and is below, along with the murmur.

1. What is the diagnosis?
2. How would you describe this murmur?
3. Where would you expect this murmur to radiate?
4. What is the classic triad associated with this condition?

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Answer

1. Aortic Stenosis due to a calcified aortic valve
2. High-pitched, crescendo-decrescendo (diamond shaped), midsystolic, ejection murmur with a soft S2
3. AS murmurs transmit well and equally to the carotid arteries
4. The classic triad of AS is exertional angina, exertional dyspnea, and dizziness/syncope