A thorough evaluation suggested the patient’s initial diagnosis was not quite right; but it was not wrong, either. An 83-year-old woman with presumed aortic stenosis was referred to our medical center for aortic valve replacement. She first presented at another facility with a 3-month history of worsening shortness of breath, particularly on exertion. Whereas she had once been able to walk 3 miles without effort, she was now winded after 1 block.
The patient denied syncope, orthopnea, paroxysmal nocturnal dyspnea, lower extremity edema, or significant weight change. A left heart angiogram showed a hyperdynamic left ventricle, and coronary angiography demonstrated a stable 50% ostial left anterior descending lesion. Hemodynamic measurements detected a mean gradient from the left ventricle to the aorta of 31 mmHg; the aortic valve area was calculated as 0.8 sq cm.
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– Christopher Vanichsarn, MD, Robert James Siegel, MD
This article originally appeared in the October 2015 issue of The American Journal of Medicine.
