Aortic Stenosis
Progressive narrowing of the aortic valve forces the left ventricle to generate ever-higher pressures to maintain forward flow, and the compensatory hypertrophy this produces keeps patients symptom-free for years until the ventricle finally fails, giving the classic late triad of angina, syncope and heart failure.
In a nutshell
Aortic stenosis is a fixed outflow obstruction that the ventricle compensates for by concentric hypertrophy, keeping patients asymptomatic despite a severe gradient. Once the hypertrophied, ischaemia-prone, output-limited ventricle can no longer compensate, angina, exertional syncope and heart failure appear, and symptom onset, not gradient alone, triggers valve replacement.
Classic presentation
An older adult with an incidental ejection systolic murmur radiating to the carotids, who develops exertional breathlessness, angina or syncope as the disease progresses.
Key points
- Severe AS can be entirely asymptomatic for years because concentric hypertrophy compensates; gradient severity and symptom status are not the same thing.
Educational content pending clinical review. Not medical advice.