Clinical Features

The classic symptoms of AS are:

• Breathlessness
• Chest pain
• Exertional syncope

Breathlessness is usually the first symptom, followed by paroxysmal nocturnal dyspnoea, exertional syncope, angina and acute myocardial infarction. The sudden onset of atrial fibrillation (AF) may cause an acute progression of symptoms.

Once symptoms occur prognosis is poor without surgical treatment [3]. Almost all patients with heart failure are dead within two years. Over 80% of patients who died of AS had symptoms for less than four years [3]. Sudden death is reported in 5-20% of patients but in fact is rarely truly sudden in that the patient has already developed symptoms even if not recognised as AS. Sudden death is a rare event in the truly asymptomatic patient (<1%/year) [3].

Image: Gross pathology of rheumatic heart disease.