You are here

Article Text

Article menu
Download PDFPDF
Case report
Very severe aortic stenosis masquerading as acute coronary syndrome
  1. Soumitra Ghosh1,
  2. Akash Batta1,
  3. Yash Paul Sharma2 and
  4. Prashant Panda3
  1. 1Department of Cardiology, PGIMER, Chandigarh, Chandigarh, India
  2. 2Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
  3. 3Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
  1. Correspondence to Dr Prashant Panda; prashantpanda85{at}gmail.com

Abstract

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.

  • cardiovascular medicine
  • valvar diseases
  • interventional cardiology

https://doi.org/10.1136/bcr-2021-244627

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Twitter @DrSoumitraGhos1

    • Contributors SG, AB, PP drafting, analysis, interpretation and manuscript preparation; YS drafting and revising its intellectual content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.