Very severe aortic stenosis masquerading as acute coronary syndrome

2021 ◽  
Vol 14 (12) ◽  
pp. e244627
Author(s):  
Soumitra Ghosh ◽  
Akash Batta ◽  
Yash Paul Sharma ◽  
Prashant Panda
Keyword(s):  
Acute Coronary Syndrome ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Peak Velocity ◽  
Severe Aortic Stenosis ◽  
Cardiac Biomarker ◽  
Coronary Syndrome ◽  
Haemodynamic Stress ◽  
Early Use ◽  
High Level

Severe aortic stenosis (AS) may rarely present like acute coronary syndrome with increased cardiac biomarker despite having normal coronaries. Here we describe a case of very severe AS, who presented with exertional and rest angina and a high level of TnI. Angiography revealed normal coronaries. Echocardiography showed very severe AS with peak velocity of 5.08 m/s and maximum and mean gradient of 103 and 54 mm Hg, respectively. The patient subsequently underwent aortic valve replacement (AVR) successfully. Subendocardial ischaemia may occur in patients with severe AS during haemodynamic stress, even in the setting of normal unobstructed coronaries due to supply-demand mismatch. Subsequent degeneration and death of the cardiac myocytes cause cTnI elevation, which anticipates the start of the clinical downhill course in severe AS. Our case highlights the importance of thorough physical examination and early use of echocardiography in patients with angina to detect the presence of severe AS.

Abstract 15292: Acute Coronary Syndrome in Patients With Severe Aortic Stenosis Undergoing TAVR: A Retrospective Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Saad M Amin ◽  
Harsh Mehta ◽  
AKHTAR AMIN
Keyword(s):  
Acute Coronary Syndrome ◽  
Aortic Stenosis ◽  
Retrospective Analysis ◽  
Severe Aortic Stenosis ◽  
Kidney Injury ◽  
Coronary Syndrome ◽  
Transcatheter Aortic Valve ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage

Introduction: Transcatheter aortic valve replacement (TAVR) has been increasingly utilized in patients with Aortic Stenosis (AS). The purpose of this study is to document the incidence of acute coronary syndrome (ACS) in patients with a history of severe Aortic Stenosis (AS) undergoing TAVR. Methods: Using the Nationwide Inpatient Sample (NIS) for years 2015 to 2017, we performed a retrospective analysis of adults over 18 years of age who underwent TAVR and their inpatient course was complicated by ACS. We further analyzed the comorbidities and complications associated with patients who developed ACS during the same hospitalization. Results: We divided a total of 69,584 patients with ACS, who underwent TAVR into two groups: patients with ACS (2.11%) and patients without ACS (97.89%). From 2015 to 2017 there was a decline in the incidence of ACS in patients undergoing TAVR from 2.62% to 1.93%. There were no demographic differences between the two groups. Comorbidities like diabetes, peripheral vascular disease, end-stage renal disease and chronic liver disease were more prevalent in ACS group (Table 1). Patients with ACS had a higher history of previous PCI (4.42% vs 2.64% p-0.08). Complications like cardiogenic shock (11.9% vs 1.29% p-<0.05), acute respiratory failure (25.17% vs 4.1% p <0.05), acute kidney injury requiring dialysis (1.7% vs 0.46% p<0.05) and cardiac arrest (4.08% vs 0.78% p<0.05) were more prevalent in the ACS group. Overall, in-hospital mortality (3.41% vs 1.42% p< 0.05) and length of stay (12.22 days vs 4.20 days p<0.05) was higher in the ACS group. Conclusions: A steady decline was noted in the number of cases complicated by ACS undergoing for TAVR over 3 years. ACS in TAVR cases was associated with higher rates of complications, prolonged hospitalizations and higher mortality.

scholarly journals Use of routinely captured echocardiographic data in the diagnosis of severe aortic stenosis

Heart ◽  
2018 ◽  
Vol 105 (2) ◽  
pp. 112-116 ◽  
Author(s):  
Steven M Bradley ◽  
Katie Foag ◽  
Khua Monteagudo ◽  
Pam Rush ◽  
Craig E Strauss ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Peak Velocity ◽  
Severe Aortic Stenosis ◽  
Clinical Care ◽  
Velocity Ratio ◽  
High Sensitivity ◽  
Aortic Valve Area

ObjectiveTo determine the implications of applying guideline-recommended definitions of aortic stenosis to echocardiographic data captured in routine clinical care.MethodsRetrospective observational study of 213 174 patients who underwent transthoracic echocardiographic imaging within Allina Health between January 2013 and October 2017. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of echocardiographic measures for severe aortic stenosis were determined relative to the documented interpretation of severe aortic stenosis.ResultsAmong 77 067 patients with complete assessment of the aortic valve, 1219 (1.6%) patients were categorised as having severe aortic stenosis by the echocardiographic reader. Relative to the documented interpretation, aortic valve area (AVA) as a measure of severe aortic stenosis had the high sensitivity (94.1%) but a low positive predictive value (37.5%). Aortic valve peak velocity and mean gradient were specific (>99%), but less sensitive (<70%). A measure incorporating peak velocity, mean gradient and dimensionless index (either by velocity time integral or peak velocity ratio) achieved a balance of sensitivity (92%) and specificity (99%) with little detriment in accuracy relative to peak velocity and mean gradient alone (98.9% vs 99.3%). Using all available data, the proportion of patients whose echocardiogram could be assessed for aortic stenosis was 79.8% as compared with 52.7% by documented interpretation alone.ConclusionA measure that used dimensionless index in place of AVA addressed discrepancies between quantitative echocardiographic data and the documented interpretation of severe aortic stenosis. These findings highlight the importance of understanding the limitations of clinical data as it relates to quality improvement efforts and pragmatic research design.

scholarly journals A Case of Critical Aortic Stenosis Masquerading as Acute Coronary Syndrome

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Siddharth A. Wayangankar ◽  
Tarun W. Dasari ◽  
Pedro M. Lozano ◽  
Karen J. Beckman
Keyword(s):  
Acute Coronary Syndrome ◽  
Aortic Stenosis ◽  
Physical Examination ◽  
Severe Aortic Stenosis ◽  
Correct Diagnosis ◽  
Critical Aortic Stenosis ◽  
Coronary Syndrome ◽  
Non Invasive ◽  
Invasive Techniques ◽  
Careful Physical Examination

Serum cardiac troponins I and T are reliable and highly specific markers of myocardial injury. Studies have shown that at least 20% of patients with severe aortic stenosis have detectable serum troponins. This case report describes a patient who presented as suspected acute coronary syndrome with markedly elevated troponin levels, who was later found to have normal coronaries and critical aortic stenosis. This case highlights the need for comprehensive and accurate physical examination in patients who present with angina. Critical aortic stenosis may cause such severe subendocardial ischemia as to cause marked elevation in cardiac markers and mimic an acute coronary syndrome. Careful physical examination will lead to an earlier use of non invasive techniques, such as echocardiography to confirm the correct diagnosis and the avoidance of inappropriate treatments such as intravenous nitroglycerin and glycoprotein IIb/IIIa inhibitors.

The Ross-Konno Procedure as Reoperative Treatment in a Young Adult with Congenital Aortic Stenosis

2012 ◽  
Vol 15 (4) ◽  
pp. 182
Author(s):  
Fotios A. Mitropoulos ◽  
Meletios A. Kanakis ◽  
Sotiria C. Apostolopoulou ◽  
Spyridon Rammos ◽  
Constantine E. Anagnostopoulos
Keyword(s):  
Young Adult ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Young Patients ◽  
Uneventful Recovery ◽  
Ross Procedure ◽  
Congenital Aortic Stenosis ◽  
Biological Prostheses

<p>Mechanical and biological prostheses are valid options when aortic valve replacement is necessary. The Ross procedure is also an alternative solution, especially for young patients.</p><p>We describe the case of a young patient with congenital aortic stenosis and bicuspid aortic valve who presented with dyspnea on exertion. An open commissurotomy was performed, and within 8 months the patient developed recurrent symptoms of severe aortic stenosis. He underwent redo sternotomy and a Ross-Konno procedure with an uneventful recovery.</p>

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