Exertional syncope and aortic stenosis

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A 63-year-old man presents with new-onset exertional syncope and is found to have aortic stenosis. In counseling the patient, you tell him that your therapeutic recommendation is based on the observation that untreated patients with his presentation have a predicted average life span of: 

A. 5 years 

B. 4 years 

C. 3 years 

D. 2 years 

E. 1 year 

The answer is C. (HPIM 20th edition, Chap. 256) Exertional syncope is a late finding in aortic stenosis and portends a poor prognosis. Patients with this symptom or with angina pectoris have an average time to death of 3 years. Patients with dyspnea have an average time to death of 2 years, and patients with heart failure have an average time to death of 1.5–2 years. Given these data, patients with severe aortic stenosis and symptoms should strongly be considered for surgical therapy.