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Natural History of Symptomatic AS — EECC MCQ

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EasyValvular Heart DiseaseNatural History of Symptomatic ASEECC

A 70-year-old man with severe aortic stenosis has been managed conservatively due to patient preference. He now presents with syncope during exertion. What is the expected natural history without intervention?

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Correct answer: B — Once symptoms develop (angina, syncope, or heart failure), the average survival without AVR is 2-3 years for angina, 1-2 years for syncope, and <1 year for heart failure

Exertional syncope in a patient with known severe aortic stenosis means the disease has become symptomatic. This is the key turning point in the natural history: untreated symptomatic severe AS has a very poor prognosis and medical therapy does not correct the fixed outflow obstruction or normalise survival. UK practice therefore treats symptomatic severe valve disease as an indication for valve intervention if appropriate. For exam purposes, the classic survival figures without AVR are approximately 2–3 years after angina develops, 1–2 years after syncope develops, and less than 1 year once heart failure develops. Therefore the correct option is C.

Reference: NICE Clinical Guideline CG109, Transient loss of consciousness ('blackouts') in over 16s, Appendix D6 section 3.2.1 Aortic stenosis prognosis; guideline last updated 2023. https://www.nice.org.uk/guidance/cg109/resources/appendix-d6-pdf-4901164884