Atypical Presentations of Patients With Calcific Aortic Stenosis

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Abstract
The diagnostic problems of atypical presentation in two patients with severe aortic stenosis, one without evidence of left ventricular hypertrophy (LVH) on electrocardiogram or x-ray film of the chest and one with significant systemic hypertension, led to a search for similar patients. Of 59 adult patients with severe aortic stenosis confirmed by cardiac catheterization, nine had a normal ECG (with Sokolow-Lyon voltage criteria for LVH) and five had sustained diastolic hypertension. Other voltage criteria were applied to the nine patients with normal ECGs; two showed no LVH by any criteria. Five of the 59 patients had sustained diastolic systemic hypertension (diastolic cuff pressures greater than 100 mm Hg) and presented as clinical diagnostic problems. Cardiac catheterization confirmed severity of aortic stenosis in all. Although unusual, severe aortic stenosis may be associated with a normal ECG and systemic hypertension.