A 60-year-old man presents with syncope on exertion and angina. On examination, a harsh systolic ejection murmur is heard over the right clavicle radiating to the neck. Pulse volume is reduced in both arms with a blood pressure difference of 40 mmHg between arms. CT angiography confirms significant stenosis of the ascending aorta. What is the most likely underlying pathology?
- A Atherosclerotic aortic valve stenosis ✓
- B Takayasu arteritis
- C Subclavian steal syndrome
- D Coarctation of the aorta
Correct answer: A. Atherosclerotic aortic valve stenosis
Explanation
Severe aortic valve stenosis presents with the classic triad of angina, syncope, and heart failure. The systolic ejection murmur radiating to the neck, reduced pulses, and inter-arm blood pressure difference reflect the pressure gradient across a stenotic valve. Takayasu arteritis is a large vessel vasculitis that does not primarily affect the aortic valve. Subclavian steal causes vertebrobasilar symptoms, not outflow obstruction murmurs.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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