Classic triad of Aortic Stenosis

classic triad of Aortic Stenosis:

Q1. What is the classic clinical triad of severe aortic stenosis?

The classic triad is Angina, Syncope, and Dyspnea (heart failure).

Q2. Angina in aortic stenosis is mainly due to:

LV hypertrophy increases demand while perfusion falls, causing angina.

Q3. Syncope in aortic stenosis most often occurs during:

Fixed cardiac output prevents adequate cerebral perfusion during exertion.

Q4. Dyspnea in aortic stenosis is primarily due to:

LV hypertrophy → ↑ LVEDP → pulmonary congestion → dyspnea.

Q5. Presence of the triad in aortic stenosis indicates:

Symptomatic AS with triad = poor prognosis without AVR.

Q6. Average survival after angina in AS (no valve replacement):

Angina → average survival ~5 years without AVR.

Q7. Average survival after syncope in AS (no valve replacement):

Syncope → average survival ~3 years without AVR.

Q8. Average survival after heart failure in AS (no valve replacement):

Heart failure → worst prognosis, survival ~2 years without AVR.

Q9. Definitive treatment for symptomatic severe AS:

AVR (surgical/TAVR) is the only definitive treatment.

Q10. Which feature is NOT part of the classic AS triad?

Palpitations are not in the classic triad.

Q11. Mechanism of exertional syncope in AS:

Exertion + fixed output → cerebral hypoperfusion → syncope.

Q12. LV hypertrophy in AS leads to:

Concentric LVH increases oxygen demand → ischemia risk.

Q13. Which symptom carries the worst prognosis?

HF → survival ~2 years, poorest prognosis.

Q14. Most common first symptom of severe AS:

Dyspnea is often the first presenting symptom.

Q15. Which type of hypertrophy is seen in AS?

Pressure overload → concentric LV hypertrophy.

Q16. Prognosis of severe AS without symptoms:

Asymptomatic AS → good prognosis until symptoms appear.

Q17. Best test to confirm AS severity:

Echocardiography = gold standard for AS severity.

Q18. Angina in AS with normal coronaries is due to:

LVH raises demand, perfusion falls → angina.

Q19. Which symptom is least specific for AS severity?

Angina may be due to coexistent CAD, not only AS severity.

Q20. The presence of the triad in AS mandates:

Triad symptoms → urgent AVR (SAVR/TAVR).
Symptom Average survival without valve replacement Clinical takeaway
Angina ≈ 5 years Indicates limited coronary reserve — consider AVR evaluation.
Syncope (exertional) ≈ 3 years Sign of advanced disease — urgent cardiology assessment recommended.
Dyspnea / Heart failure ≈ 2 years Worse prognosis — prompt valve intervention usually required.
Note: These are approximate average survival times after symptom onset if no aortic valve replacement is performed. Individual prognosis varies — manage per clinical context.

Prognosis of Severe Symptomatic Aortic Stenosis

Prognosis of Severe Symptomatic Aortic Stenosis
Angina → Average survival ≈ 5 years (if untreated)
Syncope (exertional) → Average survival ≈ 3 years
Dyspnea / Heart failure → Average survival ≈ 2 years
Once symptoms appear → prognosis declines rapidly
Valve replacement (surgical or transcatheter) dramatically improves survival

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