A 75-year-old woman presents with exertional syncope. On examination, a harsh systolic crescendo-decrescendo murmur is heard at the right upper sternal border with radiation to the carotids. What is the most likely diagnosis?

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Aortic stenosis. Exertional syncope with a harsh systolic crescendo-decrescendo murmur at the right upper sternal border radiating to the carotids is classic for aortic stenosis. This is particularly common in elderly patients and is one of the triad of symptoms (syncope, angina, and heart failure) that indicate severe aortic stenosis.

A 75-year-old woman presents with exertional syncope. On examination, a harsh systolic crescendo-decrescendo murmur is heard at the right upper sternal border with radiation to the carotids. What is the most likely diagnosis?

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