Syncope and chest pain at rest in aortic stenosis

Angina pectoris occurs in 30–40% of patients with aortic stenosis, despite a normal coronary circulation. This along with syncope, classically occurs during exercise. There are a number of suggested pathophysiological mechanisms for these symptoms, all of which lead to an imbalance between myocardial oxygen supply and demand. We report an 81-year-old patient who had several episodes of chest pain occurring at rest, leading to syncope resulting in electro-mechanical disassociation (EMD) cardiac arrest. The electrocardiogram (ECG) during these episodes showed profound ST depression, leading to the hypothesis that the underlying pathophysiology was due to myocardial ischaemia caused by the aortic stenosis alone.