Long-standing in Medicine / Internal Medicine — 70yo Man | Cardiology | SMLE Q#12312
SMLE Question #12312
Medicine / Internal Medicine
Cardiology
Objective: OBJ-163
Last updated: February 2026
A 70-year-old man with long-standing, well-controlled hypertension attends a routine clinic visit. He denies dyspnea, chest pain, presyncope, or syncope and reports good exercise tolerance. Cardiac examination reveals a harsh crescendo–decrescendo systolic murmur at the right upper sternal border radiating to the carotids and a delayed, low-volume carotid upstroke. ECG shows left ventricular hypertrophy. Transthoracic echocardiography shows severe calcific aortic stenosis with preserved left ventricular ejection fraction and concentric hypertrophy. What is the most appropriate next step in management?
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