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A 72-year-old man collapses while climbing stairs. On examination, his pulse is 78 bpm regular, BP 118/92 mmHg with a narrow pulse pressure, and there is an ejection systolic murmur radiating to the carotids. What is the most appropriate next investigation?
Examiner's thinking
Syncope on exertion misdirects toward PE, but the narrow pulse pressure plus ejection systolic murmur radiating to carotids is the tell for severe aortic stenosis. Stress testing is a deliberate trap — contraindicated in symptomatic severe AS.