Table 24. Step 3: Evaluation of severe aortic stenosis symptoms.

	Symptoms
Dyspnea	Diastolic dysfunction: LV hypertrophy ➔ reduced compliance ➔ shifting of the ventricular pressure/volume curve up and to the left ➔ increased filling pressures ➔ pulmonary capillary hypertension Systolic dysfunction: related to afterload mismatch and low-flow/low-gradient states Patients with unclear symptomology (pseudo-asymptomatic) may undergo exercise test (ergometry or ergospirometry) for evaluation of dyspnea during exertion
Angina	Imbalance in oxygen supply/consumption in the hypertrophic myocardium Reduced myocardial perfusion gradient (elevated end diastolic pressure)
Syncope	Results from inability to increase cardiac output in situations of significant reduction in total peripheral resistance May result from use of vasodilators (common triggering agents) 50% of cases are associated with cardioinhibitory reflex