Aortic Stenosis 1

Question

Vignette: A 66-year-old male presents to the clinic for a follow-up visit. He has a history of hypertension, type 2 diabetes, and hyperlipidemia. His medications include lisinopril, metformin, and atorvastatin. He reports feeling generally well but notes that he has been experiencing some decreased exercise tolerance and dyspnea on exertion over the past few months. He denies chest pain, orthopnea, or paroxysmal nocturnal dyspnea. On physical examination, the patient's blood pressure is 132/88 mmHg, pulse is 78 beats/min, and respirations are 16 breaths/min. His cardiopulmonary examination reveals a systolic ejection murmur heard best at the base of the heart that increases with standing and decreases with squatting. What is the most likely diagnosis?

Choices

A) Aortic stenosis

B) Aortic regurgitation

C) Mitral stenosis

D) Mitral regurgitation

E) Hypertrophic cardiomyopathy

Answer

E) Hypertrophic cardiomyopathy

Explanation

The patient's examination findings of a systolic ejection murmur best heard at the base of the heart that increases with standing (decreased left ventricular volume) and decreases with squatting (increased left ventricular volume) are characteristic of hypertrophic cardiomyopathy (HCM). HCM is a genetic disorder that causes thickening of the ventricular septum, which can obstruct the left ventricular outflow tract, particularly during conditions of decreased volume. This can cause symptoms of dyspnea and decreased exercise tolerance, as seen in this patient. The other options listed do not match the presentation and physical findings. Aortic stenosis would typically present with a harsh systolic murmur that radiates to the carotids. aortic regurgitation presents with a diastolic blowing murmur. Mitral stenosis presents with a diastolic rumble at the apex. mitral regurgitation presents with a holosystolic murmur at the apex radiating to the axilla.