Isolated valvular aortic stenosis. Clinico-pathological findings in an autopsy material of elderly patients

In a review of 2557 autopsy reports from a general hospital 20 patients, aged 65 or above, have been found to have severe isolated valvular aortic stenosis. The diagnosis was made or suggested clinically in only 5 cases. The clinical findings were often atypical, e.g. the BP amplitude was above 50 mmHg in 9 patients and 4 had a systolic BP of 180 mmHg or more. Left ventricular hypertrophy as evaluated by ECG was, however, present in all examined cases but one. The main cause of death was cardiac in 17 cases, of whom 2 died suddenly and 4 following non-cardiac surgery. At autopsy significant coronary arteriosclerosis was found in all but 2 patients. In 9 patients acute myocardial infarction was demonstrated--in 2 cases only through a macroscopic enzyme test (Nitro-BT method).