A 63 year old man presents with a triad of angina, syncope and congestive heart failure. Which of the following valvular heart lesion can be suspected -

Ans. is 'c' i.e., Aortic stenosis Patients with Aortic stenosis usually remain asymptomatic.Symptoms occur only with severe aortic stenosis (when the valve has narrowed to .5 cm2/m2 body surface area in adult).Cardinal symptoms of Aortic stenosis are.Exertional dyspnoeaSyncopeAngina pectoris About other options :Mitral stenosis -In mitral stenosis symptoms are attributed to increased left atrial pressure which is transmitted to pulmonary veins as well.The increased pulmonary venous pressure results in pulmonary capillary engorgement and pulmonary congestion which produces dyspnea the commonest symptom of mitral stenosis.Other symptoms of mitral stenosis are.CoughHemoptysisParoxysmal nocturnal dyspnoeaAttacks of acute pulmonary edema Tricuspid regurgitationIn TR the symptoms are attributed to increase in right ventricular overload.The symptoms and signs of Tricuspid regurgitation are identical to those resulting from right ventricular failure due to any cause.Aortic regurgitationIn aortic regurgitation the symptoms occur due to large stroke volume, so the main symptom is palpitation.With mild to moderate aortic regurgitation the forward flow can be raised effectively on exeresis so fatigue and angina are not the early symptoms.