Severe Aortic Stenosis: ECG Abnormalities as the First Clue in Emergency Care

Aortic stenosis (AS) is a progressive valvular disease that presents with subtle symptoms in the emergency department, leading to delayed diagnosis. While acute presentations of valvular pathology exhibit dramatic clinical signs, most cases are chronic and commonly discovered incidentally during routine evaluations. Compensatory adaptations, including cardiac remodeling and atrial augmentation of preload, temporarily sustain cardiac function and mask disease severity, increasing the risk of heart failure and sudden cardiac death. This case-based article details the diagnostic journey of a 59-year-old male who presented with elevated blood pressure and lightheadedness. Abnormal electrocardiogram (ECG) findings prompted further evaluation, underscoring the importance of early recognition of ECG abnormalities. The article highlights the crucial role of advanced practice emergency providers in conducting timely cardiac assessments. By proposing a systematic approach from initial ECG findings to definitive imaging, it aims to enhance early intervention and ultimately improve patient outcomes in cases of AS.