Clinical-manifestations-aortic-stenosis

(usually indicates AVA <1 cm2 or concomitant CAD

• Angina: ↑ O2 demand (hypertrophy) + ↓ O2 supply (↓ cor perfusion pressure) ± CAD
• Syncope (exertional): peripheral vasodil. w/ fixed CO → ↓ MAP → ↓ cerebral perfusion
• Heart failure: outflow obstruct + diastolic dysfxn → pulm. edema, esp. if ↑ HR/AF (↓ LV fill.)
• Acquired vWF disease (~20% of sev. AS): destruction of vWF; GI angiodysplasia
• Natural hx: usually slowly progressive (AVA ↓ ~0.1 cm2/y, but varies; Circ 1997;95:2262), until sx develop; mean survival based on sx: angina = 5 y; syncope = 3 y; CHF = 2 y