A 7-year-old boy has a harsh ejection systolic murmur at the right upper sternal border radiating to the carotids, preceded by a click that does not vary with respiration. He reports chest pain and fainting during football. What is the MOST likely diagnosis?

• A Small muscular ventricular septal defect
• B Pulmonary valve stenosis
• C Valvar aortic stenosis ✓
• D Idiopathic hypertrophic subaortic stenosis

Explanation

An ejection click followed by a murmur radiating to the carotids localizes to the aortic valve, and exertional syncope signals significant obstruction demanding prompt evaluation. The click of valvar aortic stenosis is constant because it arises from the abnormal valve itself, unlike the pulmonary ejection click which softens with inspiration. HCM gives a murmur that increases with Valsalva and lacks a typical ejection click, and a small VSD produces a pansystolic murmur.

Reference: Park's Pediatric Cardiology for Practitioners, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.