EDUCATION IN HEART

Valve disease

Low "gradient", low flow aortic stenosis

John Chambers

Correspondence to:
Correspondence to:
Dr John Chambers
Cardiothoracic Centre, St Thomas Hospital, London SE1 7EH, UK; jboydchambers@aol.com

Keywords: aortic stenosis; continuity equation; echocardiography; heart failure; valve disease

The first 150 words of the full text of this article appear below.

Aortic stenosis is thought to have a long, asymptomatic latent phase during which the risk of sudden death is low. In fact symptoms can be revealed by treadmill exercise in a large proportion of apparently asymptomatic patients.¹ Patients may limit exercise to avoid symptoms or may fail to recognise the presence of exertional breathlessness or ascribe it to old age or some other condition. Such patients may then present in heart failure with relatively advanced disease when the left ventricle decompensates.² Even in the presence of overt symptoms, physicians may fail to make the diagnosis³ often in the mistaken belief that severe aortic stenosis cannot coexist with systemic hypertension.⁴ Sometimes heart failure is precipitated in truly asymptomatic aortic stenosis by myocardial infarction, sepsis or another stress like non-cardiac surgery. For these reasons, the initial presentation for about 5% of patients having surgery is with heart failure⁵ rather than . . . [Full text of this article]

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