# A Case of Severe Aortic Stenosis Mimicking Acute Coronary Syndrome: Diagnostic Challenges and Surgical Management

## TL;DR

A patient with chest pain and heart symptoms was found to have a severe heart valve issue and infection, not a heart attack.

## Contribution

Highlights the diagnostic challenge of aortic stenosis mimicking acute coronary syndrome and the importance of thorough evaluation.

## Key findings

- A 52-year-old male presented with ACS-like symptoms but was diagnosed with severe aortic stenosis and infective endocarditis.
- The case emphasizes the need for comprehensive imaging and evaluation in atypical ACS presentations.
- Successful surgical management was achieved through a Bentall procedure.

## Abstract

Chest pain with elevated troponin and ECG changes often prompts a diagnosis of acute coronary syndrome (ACS). However, this presentation can mask other critical pathologies. We report a case of a 52-year-old male who presented with exertional chest discomfort and progressive dyspnea. Initial workup, including troponin elevation and lateral ST-segment depression, led to a presumptive diagnosis of ACS. However, further imaging revealed severe aortic stenosis (AS) secondary to a bicuspid aortic valve (BAV), with a significantly dilated ascending aorta. Intraoperatively, an annular abscess was discovered beneath the right coronary cusp, confirming a missed diagnosis of infective endocarditis (IE). The patient underwent a successful Bentall procedure with aortic root and valve replacement. This case illustrates the diagnostic challenge posed by overlapping cardiovascular pathologies and emphasizes the importance of thorough evaluation in patients with atypical ACS presentations, particularly when structural heart disease is suspected.