A 75-year-old man is bought to the hospital because of a syncopal episode. There was no incontinence or post-event confusion. On examination, his blood pressure is 140/80 mm Hg, pulse 72/min with no postural changes. His second heart sound is diminished and there is a systolic ejection murmur that radiates to the carotids. With the Valsalva maneuver, the murmur decreases in length and intensity.For the above patient with a systolic murmur, select the most likely diagnosis.
High-Yield Explanation
With the Valsalva maneuver, most murmurs will decrease. The location and radiation of this patient's murmur suggests aortic stenosis. The exceptions are the murmurs of HOCM and mitral valve prolapse, which increase.After release of the Valsalva maneuver, right-sided murmurs tend to return to baseline more rapidly.