First presentation of Aortic Stenosis as VF arrest and role of POCUS
Dr Himanshu Gul Mirani
Case Presentation:
A 50-year-old previously well male collapsed while walking and received immediate bystander cardiopulmonary resuscitation with a single defibrillation shock, achieving return of spontaneous circulation. Electrocardiography suggested left ventricular hypertrophy without ST-segment elevation. Examination revealed a loud ejection systolic murmur.
Aortic stenosis on POCUS - qualitative assessment on eyeballing
Management and Outcome:
POCUS echocardiography demonstrated concentric left ventricular hypertrophy and markedly reduced aortic valve cusp excursion, consistent with severe aortic stenosis. There was no systolic anterior motion (SAM) of the mitral valve to suggest obstructive cardiomyopathy. Formal echocardiography confirmed the diagnosis, and the patient was referred for definitive aortic valve replacement.
Key Learnings and Points:
Extending emergency echocardiography to include focused valvular assessment can significantly alter diagnosis, management, and disposition. Early recognition of major valvular pathology enables appropriate escalation of care, specialist involvement, and avoidance of diagnostic delay.