from Boards&Beyond- Aortic stenosis leads to Syncope, Angina, and Left heart failure. Syncope is due to failure to increase cardiac output due to increased afterload. Angina is due to increased LVEDP which leads to decreased coronary blood flow. And left heart failure is due to increased LVEDP.
described a classical murmur of AS (late peaking, mid systolic, radiates to carotids b/l), no lesions on angio graph, ECG - LVH d/t AS most likely. its relieved on rest, rule our b) coronary spasm, an LVH wouldn't compress coronary artery (think a bit of anatomy). Mitral valve prolapse would a mid systolic click. im sure no one picked vasopressor induced hypotension; vasopressors increase blood pressure, this pt bp is 120/80 and a transient increase wouldn't lead to syncope.
the explanation of the right answer is given in other comments, just some thoughts of mine for wrong answers
submitted by โneonem(630)
this patient has symptomatic aortic stenosis. This can be identified by the ventricular hypertrophy (to compensate for increased functional afterload from non-compliant aortic valve), midsystolic murmur and the location at the normal aortic area.
Per UpToDate on Clinical manifestations of Aortic Stenosis:
"Dizziness and syncope โ Syncope occurs as a presenting symptom in approximately 10 percent of patients with symptomatic severe AS (or approximately 3 percent of all patients with severe AS) [3]. There are several proposed explanations for exertional dizziness (presyncope) or syncope in patients with AS, both of which reflect decreased cerebral perfusion. Exercise-induced vasodilation in the presence of an obstruction with fixed cardiac output can result in hypotension."