Triad: Angina, Syncope, Dyspnea (exertional). Harsh crescendo-decrescendo systolic murmur at R 2nd ICS radiating to carotids; pulsus parvus et tardus.
Gold Standard Diagnosis
Echocardiography (valve area, mean gradient, EF). Severe: area <1 cm², mean gradient >40 mmHg.
First-line Treatment
Valve replacement (SAVR or TAVR) once symptomatic or severe with ↓EF. No medical therapy halts progression; avoid aggressive afterload reduction/diuresis.
High-Yield Pearl
Symptom onset (angina → syncope → HF) marks a sharp drop in survival → refer for replacement. Bicuspid valve = AS in younger patients.