Sudden cardiac death in asymptomatic aortic stenosis: is the valve to blame?

Abstract

An active 68-year-old man with asymptomatic severe aortic stenosis and normal functional capacity on a conventional bicycle exercise test underwent a haemodynamic stress test with simultaneous invasive haemodynamic monitoring and echocardiography during supine bicycle testing as part of a research project. With exercise, the patient developed pulmonary venous hypertension and mild regional wall motion abnormalities on echocardiography. The patient terminated the test due to exhaustion. In the recovery period, he developed sustained ventricular tachycardia and became unconscious. No symptoms were present during exercise or prior to cardiac arrest. The following coronary angiogram revealed significant 2-vessel disease, and the patient subsequently underwent successful aortic valve replacement and coronary-artery bypass graft surgery.

Genetic Variants as Sudden-Death Risk Markers in Inherited Arrhythmogenic Syndromes: Personalized Genetic Interpretation

“…Further, relatives from the same family can have different clinical presentations, from asymptomatic, to SCD with previous syncope, or even the first manifestation of disease without any previous symptoms. Initial phenotypic alterations may not be visible at autopsy, can be unspecific, or can be within the normal range [ 6 ]. Thus, almost 40% of SCD cases do not present cardiac anomalies after complete autopsy, and lethal IAS is often designated as the most plausible cause of death [ 7 ].…”