Which symptom cluster is classically associated with severe aortic stenosis?

Which symptom cluster is classically associated with severe aortic stenosis?

• A. Cough, fever, and fatigue
• B. Palpitations, weight gain, and edema
• C. Syncope, angina, and dyspnea on exertion
• D. Hemoptysis, night sweats, and chest pain

Answer: (C)

Severe aortic stenosis produces a fixed cardiac output with progressive left ventricular hypertrophy, so exertion unmasks a mismatch between oxygen supply and demand. This leads to a classic triad: syncope on exertion from reduced cerebral perfusion when the heart cannot increase output, angina from increased myocardial oxygen demand and limited supply due to LV hypertrophy, and dyspnea on exertion from diastolic dysfunction and pulmonary venous congestion. The other symptom clusters don’t fit this pattern and are more typical of different conditions, whereas this trio directly reflects the hemodynamic burden of a severely obstructed aortic valve.

Severe aortic stenosis produces a fixed cardiac output with progressive left ventricular hypertrophy, so exertion unmasks a mismatch between oxygen supply and demand. This leads to a classic triad: syncope on exertion from reduced cerebral perfusion when the heart cannot increase output, angina from increased myocardial oxygen demand and limited supply due to LV hypertrophy, and dyspnea on exertion from diastolic dysfunction and pulmonary venous congestion. The other symptom clusters don’t fit this pattern and are more typical of different conditions, whereas this trio directly reflects the hemodynamic burden of a severely obstructed aortic valve.