Rosh Emergency Medicine Practice Test

In a patient presenting with a crescendo-decrescendo systolic murmur, what is the most common initial presenting symptom of the underlying condition?

1. Chest pain

2. Dizziness

3. Dyspnea

4. Syncope

The correct answer is: Dyspnea

A crescendo-decrescendo systolic murmur is often associated with conditions such as aortic stenosis or hypertrophic obstructive cardiomyopathy. The most common initial presenting symptom of these underlying conditions is typically dyspnea, especially on exertion. As the heart's ability to maintain adequate blood flow is compromised, patients may begin to experience shortness of breath during physical activity due to the reduced ability to increase cardiac output. This symptom is particularly prominent in older patients with aortic stenosis, as the condition gradually progresses, leading to increased exercise intolerance. While other symptoms such as chest pain, dizziness, and syncope can occur, they are generally less common as initial presentations in these conditions. Chest pain may arise due to myocardial ischemia secondary to reduced perfusion, dizziness might relate to decreased cerebral perfusion, and syncope could occur with severe hemodynamic compromise. However, dyspnea is more consistently observed as the first warning sign of significant cardiac issues related to the detected murmur.