QuestionSBA
QuestionChoice
This answer is incorrect. With an absence of cardiac risk factors and normal observations, ECG and troponin, a diagnosis of NSTEMI is unlikely.
10007267
b
Non-ST elevation myocardial infarction (STEMI)
QuestionChoice
This answer is incorrect. Aortic sclerosis is an asymptomatic condition. It causes an ejection systolic murmur which does not radiate to the carotids. It does not typically present with loss of consciousness.
10007268
c
Aortic sclerosis
QuestionChoice
This answer is correct. The ejection systolic murmur radiating to the carotids points towards a diagnosis of aortic stenosis. Patients often remain asymptomatic for a long period before decompensating and presenting acutely with a loss of consciousness or collapse, as in this scenario.
10007266
a
Aortic stenosis
QuestionChoice
This answer is incorrect. With an absence of cardiac risk factors and normal observations, ECG and troponin, a diagnosis of NSTEMI is unlikely.
10007269
d
Vasovagal syncope
QuestionChoice
This answer is incorrect. The patient's capillary blood glucose is within normal limits which rules out hypoglycaemia as a cause of his syncope.
10007270
e
Hypoglycaemia
Concept
Chapter
2693
3716
Aortic stenosis
Topic
134
Cardiology
Aortic stenosis
14000
A 64-year-old man presents to A&E after collapsing while walking to the shop, reporting breathlessness before the fall and sudden fainting.  


He did not injure himself and currently has no symptoms. This is the first time this has happened.






The patient's observations are as follows: HR 68 bpm, RR 14/min, BP 125/75 mmHg, temperature 36.7°C, and oxygen saturations 98% on room air.



Physical examination is unremarkable except for an ejection systolic murmur at the right sternal edge, radiating to the carotids.



His blood tests, including full blood count, urea and electrolytes, CRP, and troponin, are normal. His capillary blood glucose is 5.6 mmol/L, and ECG shows no abnormalities.  


Which of the following is the most likely cause of his collapse?
a