Which symptoms are included in the classic triad of aortic stenosis (AS)?

The classic triad of symptoms associated with aortic stenosis includes syncope, dyspnea, and angina. Understanding these symptoms can provide important insight into the pathophysiology of the condition.

Syncope occurs due to decreased blood flow to the brain, particularly during exertion, as the heart struggles to eject blood through the narrowed aortic valve. This is especially prominent in patients with severe stenosis who are unable to adequately increase cardiac output during physical activity.

Dyspnea, or difficulty breathing, typically arises from heart failure or pulmonary congestion as a result of the increased pressure that the left ventricle must generate to push blood through the narrowed valve. As aortic stenosis progresses, the left ventricle becomes hypertrophied and may become less compliant, leading to heart failure symptoms even at rest.

Angina can occur due to decreased coronary perfusion. As the left ventricle works harder to generate sufficient pressure for circulation, there is an increased demand for oxygen. The coronary arteries, often unaffected by stenosis, may struggle to meet this oxygen demand, leading to chest pain.

These three symptoms—syncope, dyspnea, and angina—form a critical clinical picture that guides the diagnosis and management of