A 45 year old male came with worsening breathlessness since two weeks. It has been occurring on minimal exertion and he also has had episodes of awakening from sleep due to breathlessness. He has noticed palpitations on walking and it is associated with throbbing sensations. He has central chest discomfort on walking which is relieved on rest. There is no history of cough, fever, loss of consciousness or swelling of feet or body.
He had recurrent episodes of joint pains in his adolescence associated with fever but had never been to a hospital. Since 4 years, he has noticed dyspnoea on heavy exertion. He had stopped manual labour 2 years ago but was able to carry on his daily routine activities. Since the past 4 months, he was not able to walk more than a kilometre without shortness of breath.
Examination revealed: Pulse: 80/min, regular, high volume, collapsing. JVP- normal. BP: 160/20 mmHg. CVS: Apex is in left 6th ICS, anterior axillary line, hyperdynamic. No thrill. Auscultation: Aortic area- high pitched, blowing, early diastolic murmur of grade 3 radiating to the apex. Ejection systolic murmur grade 2 also heard. Other areas- normal sounds. R/S – normal. Abdomen- normal. CNS- Normal.
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