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Syncope
19%
6/32
Angina
12%
4/32
Congestive heart failure (CHF)
50%
16/32
Hypertension
3%
1/32
Diabetes
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This patient presents with exertional syncope and physical examination findings consistent with symptomatic aortic stenosis. The development of heart failure in aortic stenosis portends an average survival of roughly 1.5 years. Patients with aortic stenosis are often asymptomatic for many years. Symptoms of aortic stenosis include angina (35%), syncope (15%), and CHF (50%). The patient’s murmur is classic for aortic stenosis. Other clinical signs and symptoms include development of an S4 heart sound, pulsus parvus et tardus, sustained PMI, and precordial thrill. Grimard reviews the diagnosis and treatment of aortic stenosis. Patients with symptomatic aortic stenosis have a poor prognosis unless valve replacement surgery is performed. Eveborn et al. studied asymptomatic aortic stenosis in 164 patients and found that mortality was largely unchanged from that of the general population. Importantly, this was revealed an accelerated progression of the aortic mean gradient as the disease advances. Incorrect Answers: Answers 1 and 2: Angina portends an average survival of 3 years in untreated patients, while syncope portends an average survival of 2 years. Answers 4 and 5: Hypertension and diabetes are not symptoms directly related to aortic stenosis and are not as good as CHF in prognosticating.
4.8
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