Diagnosis?

A 42 year old man with hypertension, but no prior cardiac history, presents with increased dyspnea on exertion. Physical examination reveals heartbeat of 75beats/min and bp of 175/67. Jugular venous pattern is unremarkable. S1 is soft and s2 is normal and there is an early systolic sound. There is a soft grade 2/6 systolic ejection murmur at right upper sternal boarder radiating to the neck and a grade 3/6 decreascendo, holodiastolic murmur near the left lower sternal boarder. There is also a low pitched diastolic rumble heard at the apex. The pmi is laterally displaced. Carotid pulsation is brisk and have a rapid upstroke, immediately followed by a second systolic pulsation. Femoral pulses are normal and slightly delayed compared to the radial pulse.

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Character of presystolic murmur and diastolic sluggish murmur with characteristic DOE All suggest valvular heart disease Likely AS/MS Adv 2decho Rx sustained propanolol Tab ecosprin Sos valvactomy

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All these findings point to AS c MS but check BP,as such a high BP can not be in stenotic lesions.kindly adv 2 D Echo. review after reports

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Is pt phase or lin and thin? It may b MS . 2 d echo??

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