A 70-year-old man with a long history of hypertension presents with exertional syncope. Auscultation reveals a harsh systolic ejection murmur radiating to the carotids with a slow-rising pulse. Autopsy of a similar case characteristically shows nodular masses of calcium heaped up within the sinuses of Valsalva. Which underlying valve abnormality predisposes to this condition at an earlier age?

• A Myxomatous degeneration
• B Rheumatic commissural fusion
• C Congenital bicuspid aortic valve ✓
• D Libman-Sacks vegetations

Explanation

Calcific aortic stenosis results from progressive calcium deposition in an otherwise normal trileaflet valve in the elderly, typically presenting after age 60 to 70. C congenital bicuspid aortic valve creates abnormal turbulent flow that accelerates calcification and causes clinically significant stenosis one to two decades earlier, often in the fifth to sixth decade. Commissural fusion is the hallmark of rheumatic disease, myxomatous change affects the mitral valve, and Libman-Sacks vegetations are small and sterile.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.