Question

A 70-year-old man is brought to the Emergency Room because he lost consciousness while working in the garden. He says that he had several episodes of near-syncope on exertion recently. His past medical history is insignificant. He is not taking any medications. His blood pressure is 110/85 mmHg and heart rate is 80/min. Point of maximal impulse is increased in intensity. Cardiac auscultation reveals ejection-type systolic murmur at the base of the heart with radiation to the carotid arteries. ECG demonstrates left ventricular hypertrophy, and secondary ST segment and T wave changes.

What is the most probable cause of this patient's condition?

• A. Rheumatic endocarditis

• B. Bacterial endocarditis

• C. Hypertension

• D. Congenital anomaly

• E. Age-related sclerocalcific changes

Answer:

Correct Cause: E. Age-related sclerocalcific changes

Final Insight: Age-related changes lead to aortic stenosis, resulting in LVH and exertional symptoms. Other options are ruled out based on patient history and clinical presentation.

Patient Age: 70 years old
⬇️
Increased prevalence of age-related cardiovascular changes 🧠
⬇️
Aortic Stenosis due to age-related sclerocalcific changes

⬇️
Calcification and narrowing of aortic valve
⬇️
↑ Left ventricular pressure overload
⬇️
Left Ventricular Hypertrophy (LVH) 🧠
⬇️
ECG shows LVH + ST segment and T wave changes

Symptoms Due to Aortic Stenosis
⬇️
Decreased cardiac output during exertion
⬇️
Episodes of near-syncope 🧠
⬇️
Increased risk of syncope while exerting (e.g., gardening)

Why Other Answers Are Wrong?

A. Rheumatic Endocarditis
⬇️
Multiple valve involvement + younger age
⬇️
Unlikely cause in this patient 🧠

B. Bacterial Endocarditis
⬇️
Presence of systemic infection signs (e.g., fever)
⬇️
No signs of infection present in this patient 🧠

C. Hypertension
⬇️
↑ Blood pressure may cause LVH
⬇️
No evidence of hypertension (BP: 110/85 mmHg) 🧠

D. Congenital Anomaly
⬇️
Typically presents in younger patients
⬇️
No history of congenital heart disease 🧠

Flashcards

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