Incidence is 4 in 1000 live births. Patients with exertional angina or syncope survive an average of 3 years. After the development of left ventricular failure, life expectancy is slightly greater than 1 year. The etiology of AS in those aged 30-70 years can be rheumatic disease or calcification of a congenital bicuspid valve. AS usually has an asymptomatic latent period of 10-20 years.
Symptoms develop gradually.
Ultimately, patients experience the classic triad of chest pain, heart failure, and syncope. Patients may have a higher incidence of nitroglycerin-induced syncope than the general population. Always consider AS as a possible etiology for a patient in the ED with particular hemodynamic sensitivity to nitrates. This is due to an elevation of the pulmonary capillary pressure from left ventricular dilation and reduced compliance. A systolic thrill may be palpable at the base of the heart, in the jugular notch, and along the carotid arteries.