Intensive Care Medicine (ICM) Practice Exam

What clinical sign is most indicative of significant aortic stenosis?

1. Bounding pulses

2. Faint heart sounds

3. Decreased blood pressure

4. Triad of exertional dyspnea, angina, syncope

The correct answer is: Triad of exertional dyspnea, angina, syncope

The triad of exertional dyspnea, angina, and syncope is highly indicative of significant aortic stenosis due to the physiological changes that occur with the condition. Aortic stenosis leads to an obstruction of blood flow from the left ventricle to the aorta during systole, which in turn results in left ventricular hypertrophy as the heart works harder to pump blood through the narrowed valve. When patients with significant aortic stenosis exert themselves, they often experience dyspnea due to insufficient cardiac output to meet the increased demands of the body during physical activity. Angina, or chest pain, can occur because the coronary arteries may not receive enough blood supply, particularly during stress, as the hypertrophied heart muscle requires more oxygen. Syncope, or fainting, can happen due to the reduced ability to increase cardiac output during exertion, leading to inadequate cerebral perfusion. Individually, each of these symptoms can arise from various other conditions, but the combination of all three occurring together under exertional circumstances points very specifically to significant aortic stenosis, making it a classic presentation in clinical practice. Other options may represent signs that can be observed in various cardiovascular states, but none encapsulate the typical symptomatic