Hy 2545 Cardio!
30 year old female…complains of chest pain with exertion (Hint: Note the young age of the patient). The symptoms began approximately 6 months ago and have been accompanied by dyspnea. On several occasions, she became lightheaded and felt while exercising. She has no prior medical history. She does not smoke or drink or do drugs. Blood pressure is slightly elevated. She is afebrile. A head and neck examination is normal. There is no jugulovenous distention. Her lungs are clear. On cardiac examination, there is an apical impulse and a soft S2. There is a harsh, late-peaking, crescendo-decrescendo systolic murmur that is heard best at the right second intercostal space and radiates to the carotids (This is the BIG giveaway hint). The remainder of the physical examination is unremarkable. An ECG reveals a normal sinus rhythm and left ventricular hypertrophy by voltage criteria. What is the likely pathology? What is the likely mech.of action for the anginal symptoms?
1-Pulmonary stenosis
2-Aortic stenosis
3-Mitral regurg

a) #2. This is aortic stenosis likely due to a congenital bicuspid aortic valve or, less likely, as a sequelae of rheumatic valvular disease. The anginal type symptoms develop in the presence of normal coronary arteries because there is increased demand by the hypertrophied left ventricle, which exceeds the coronary arteries' ability to meet demands. Cool, eh?