CARDIOLOGY

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A 48-year-old male presented with a complaint of back pain persisting for the past 2 months. The pain began insidiously, radiating to the left side of his back, characterized as a continuous dull ache that was alleviated by rest and medication. He denied experiencing dyspnea on exertion, chest pain, palpitations, orthopnea, paroxysmal nocturnal dyspnea, cough, syncope, seizures, weakness in the upper and lower limbs, fever, joint pain, swelling of legs, puffiness of the face, abdominal distension, abdominal pain, nausea, or vomiting. His past medical history was significant for hypertension diagnosed 2 years ago, which was well controlled with oral medications. He had no notable surgical history or significant family history. His social history indicated regular bowel and bladder habits, a mixed diet, and no substance addiction.

Vitals: Temp: afebrile, pulse rate: 54 beats/min, blood pressure: 116/76 mmHg in the left arm in the supine position, Jugular venous pressure (JVP): approximately 5 cm. 

Cardiovascular examination: Revealed a normal precordium without visible scars or dilated veins. The apex beat was visible in the left 5th intercostal space, with no other pulsations observed. Palpation confirmed the apex beat in the 5th intercostal space, 1 cm medial to the midclavicular line, and it was heaving in nature without thrills. Percussion indicated that the right heart border was retrosternal, and the left heart border was along the apex beat. Auscultation revealed a grade 3/6 ejection systolic murmur in the aortic area that radiated to the carotids. The murmur was associated with an ejection click and had a harsh crescendo-decrescendo character. The murmur was best heard during expiration.

Based on these findings and the results of the ECG, chest X-ray, and echocardiogram, as shown in the images, the final diagnosis was valvular heart disease with severe aortic stenosis and mild aortic regurgitation of degenerative aetiology.

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Learn about the diagnosis and management of severe aortic stenosis and mild aortic regurgitation in a 48-year-old male. Discover the symptoms, causes, and treatment options for valvular heart disease.