A 65-year-old man comes to the physician because of a 10-day history of episodic retrosternal pain and shortness of breath. The episodes occur when he climbs stairs or tries to walk briskly on his treadmill. The symptoms resolve with rest. The previous evening he felt dizzy and weak during such an episode. Physical examination shows a mid-systolic murmur at the upper sternum and slow-rising carotid pulses. After initial evaluation, cardiac catheterization is performed and reveals 30% stenosis of the mid-left anterior descending artery. A 50 mm Hg pressure gradient is seen when a catheter is passed across the aortic valve. Which of the following is the most important contributor to this patient's presenting symptoms?

Question

A 65-year-old man comes to the physician because of a 10-day history of episodic retrosternal pain and shortness of breath. The episodes occur when he climbs stairs or tries to walk briskly on his treadmill. The symptoms resolve with rest. The previous evening he felt dizzy and weak during such an episode. Physical examination shows a mid-systolic murmur at the upper sternum and slow-rising carotid pulses.  After initial evaluation, cardiac catheterization is performed and reveals 30% stenosis of the mid-left anterior descending artery.  A 50 mm Hg pressure gradient is seen when a catheter is passed across the aortic valve.  Which of the following is the most important contributor to this patient's presenting symptoms?

Quizplus · Accepted Answer

Eductional Objective: Angina often occurs in aortic stenosis even in the absence of obstructive coronary artery disease.  It results from increased myocardial oxygen demand due to an increase in left ventricular mass (ie, concentric hypertrophy) and ventricular wall stress

A 65-Year-Old Man Comes to the Physician Because of a 10-Day