The diagnosis of severe valvular aortic stenosis due to a congenital valve defect is supported by the patient's history of a murmur since childhood and episodes of exertional syncope.
His physical examination demonstrated a narrow pulse pressure, an hypokinetic, slow-rising carotid arterial pulse with diminished peripheral pulses, a sustained apical impulse, and the classic murmur of aortic stenosis.
The most common etiologies of valvular aortic stenosis include a congenital bicuspid aortic valve, rheumatic aortic valve disease, and degenerative calcific aortic valve disease. In our patient, the history and physical findings, especially his age and the presence of an ejection sound, are most consistent with a congenital etiology.