What are the cardinal symptoms of aortic stenosis?

From the Guidelines

The cardinal symptoms of aortic stenosis are chest pain (angina), shortness of breath (dyspnea), and fainting or near-fainting episodes (syncope or presyncope), as indicated by the most recent guidelines 1. These symptoms typically develop gradually as the aortic valve narrows progressively, restricting blood flow from the left ventricle to the aorta.

• Angina occurs because the thickened heart muscle requires more oxygen than can be supplied through the coronary arteries.
• Shortness of breath results from increased pressure in the lungs as the left ventricle struggles to pump blood forward through the narrowed valve.
• Syncope happens when the fixed cardiac output cannot meet the body's demands during exertion, leading to decreased cerebral perfusion. Other symptoms may include fatigue, reduced exercise tolerance, heart palpitations, and heart failure signs such as swelling in the legs or abdomen. These symptoms typically appear late in the disease process, often when the valve area has narrowed to less than 1.0 cm², as defined by recent guidelines 1. The presence of these symptoms in a patient with severe aortic stenosis generally indicates the need for valve replacement, as symptom onset marks a significant decline in prognosis if left untreated, and is supported by guidelines from 1 and 1. In clinical practice, the management of patients with severe aortic stenosis is guided by the presence of symptoms, as well as other factors such as the severity of the stenosis and the patient's overall health status, as outlined in recent guidelines 1.

From the Research

Cardinal Symptoms of Aortic Stenosis

The cardinal symptoms of aortic stenosis indicating a need for intervention are:

• Angina
• Symptoms of heart failure
• Syncope 2, 3, 4, 5, 6

Clinical Presentation

These symptoms occur as the disease worsens and the compensatory mechanisms become inadequate, leading to:

• Decreased left ventricular function
• Increased risk of mortality 3, 4, 5, 6

Importance of Symptom Recognition

Patients with these symptoms have a much higher mortality rate than asymptomatic patients, emphasizing the importance of prompt recognition and disease-specific management 5 The presence of syncope, in particular, conveys an increased risk for mortality after surgical aortic valve replacement (SAVR) 2