[JNUS]

Most likely its a case of Aortic Stenosis, symptomatic one. Syncope suggesting low cardiac output... LVH due to AS ---> HTN . Patient is having exertional dyspea, not in failure. But patient is in risk of developing Failure and development of arrythmias ---> may lead to sudden death of the patient.

Mx of HTN will be best by ACE-I .( 1st dose hypotension -- advise patient to take 1st does in night just before sleeping). Diuretics may deplete intravascular volume, aggravating syncope.

Immediate ECHO and doppler (to measure pressure gradient) is suggested and should be Planned for Surgery ( valve replacement ) if i am correct from the begining.