Pathology
Clinical Scenario
Mr. Gerald Finch, 74, retired engineer. Referred by his GP following a 6-month history of exertional chest tightness, two episodes of syncope on exertion, and increasing breathlessness on climbing stairs. He has a known history of a bicuspid aortic valve diagnosed incidentally 20 years ago. On examination his pulse is slow-rising, blood pressure is 130/90 mmHg with a narrow pulse pressure, and a harsh ejection systolic murmur is audible at the right upper sternal edge, radiating to the carotids.
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