🩺That murmur sounds lowkey suspicious

🗒️ Question

A 68 year old woman presents to her GP with increasing shortness of breath on exertion and occasional episodes of dizziness over the past six months. She denies chest pain but reports fatigue and occasional palpitations.

On examination, her blood pressure is 115/70 mmHg, heart rate is 78 bpm and respiratory rate is 18. Auscultation reveals a loud harsh systolic murmur best heard at the right upper sternal border radiating to the carotids. There is also a delayed carotid upstroke.

What is the most likely diagnosis?

(A) Aortic stenosis

(B) Mitral stenosis

(C) Aortic regurgitation

(D) Mitral regurgitation

(E) Tricuspid regurgitation