USMLE Step 3 - Question 40

A 79 year old male presents to the emergency room with an episode of syncope. He states he had been walking on a treadmill when he became very dizzy and passed out. He denies any chest pressure or dyspnea on exertion. His temperature is 37.0, blood pressure 120/80, heart rate 90, and respirations 20. Physical examination reveals normal lung sounds, a III/VI late-peaking systolic murmur best heard at the right upper sternal border radiating to the carotid arteries, a II/VI holosystolic murmur at the cardiac apex, an S4 heart sound, an inaudible S2 heart sound, and a weak and delayed carotid impulse. Laboratory studies are normal. Which of the following is his life expectancy without aortic valve replacement?

A. Normal

B. Two years

C. Three years

D. Five years

This patient has severe aortic valve stenosis on examination and has symptoms related to it (recall syncope, angina, and dyspnea on exertion is the classic triad of aortic stenosis). No medications help with this disorder and the only treatment is aortic valve replacement. Aortic valvuloplasty is not successful due to very high restenosis rates. Without aortic valve replacement the life expectancy of symptomatic aortic stenosis is markedly reduced. The typical questions on exams would ask the life expectancy (without aortic valve replacement) based on the presenting symptoms. If someone with aortic stenosis presents with angina, the life expectancy is 5 years, syncope 3 years, and dyspnea on exertion (indicating heart failure) 2 years.