Case history
Case history
A 78-year-old man presents to his primary care physician with 2 months of progressive shortness of breath on exertion. He first recognised having to catch his breath while gardening and is now unable to walk up the stairs in his house without stopping. Prior to this, he was healthy and active. On physical examination there is a loud systolic murmur at the right upper sternal border radiating to the carotid vessels.
Other presentations
AS is a progressive disease that presents after a decades-long subclinical period with symptoms of chest pain, syncope, and heart failure. While the most common presentations are fatigue and dyspnoea with exertion, patients may also note exertional syncope or chest pain that may be identical to that caused by coronary artery disease. In its later stages, severe AS may present as heart failure. AS is often diagnosed during the subclinical phase while a murmur noted on physical examination is being investigated. Even with severe AS, patients may be asymptomatic, but often have subtle exertional symptoms. A careful history is important to determine if the patient has altered his or her habits in response to slowly worsening stenosis.
Use of this content is subject to our disclaimer