You are incorrect - the most likely diagnosis in our patient is hypertrophic obstructive cardiomyopathy.


Your choice: Membranous subvalvular aortic stenosis

Patients with discrete membranous subvalvular aortic stenosis may present with a narrow pulse pressure, an hypokinetic arterial pulse and a sustained apical impulse. Typical auscultatory findings include a systolic ejection murmur, maximal at the left sternal edge and the murmur of aortic regurgitation. Unlike valvular aortic stenosis, an ejection sound is typically absent.