Severe isolated valvular aortic stenosis was clinically diagnosed in only 5 of 20 elderly autopsy cases, with atypical clinical findings and cardiac death occurring in 17 patients.
Observational (n=20)
No
Severe isolated valvular aortic stenosis in the elderly is frequently underdiagnosed clinically and often presents with atypical findings such as wide pulse pressure and concurrent coronary artery disease.
In a review of 2557 autopsy reports from a general hospital 20 patients, aged 65 or above, have been found to have severe isolated valvular aortic stenosis. The diagnosis was made or suggested clinically in only 5 cases. The clinical findings were often atypical, e.g. the BP amplitude was above 50 mmHg in 9 patients and 4 had a systolic BP of 180 mmHg or more. Left ventricular hypertrophy as evaluated by ECG was, however, present in all examined cases but one. The main cause of death was cardiac in 17 cases, of whom 2 died suddenly and 4 following non-cardiac surgery. At autopsy significant coronary arteriosclerosis was found in all but 2 patients. In 9 patients acute myocardial infarction was demonstrated--in 2 cases only through a macroscopic enzyme test (Nitro-BT method).
Andersen et al. (Sun,) conducted a observational in Severe isolated valvular aortic stenosis (n=20). Severe isolated valvular aortic stenosis was evaluated on Clinical diagnosis and clinico-pathological findings. Severe isolated valvular aortic stenosis was clinically diagnosed in only 5 of 20 elderly autopsy cases, with atypical clinical findings and cardiac death occurring in 17 patients.