{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T18:42:34Z","timestamp":1781721754756,"version":"3.54.5"},"reference-count":9,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,11,21]]},"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:p>Severe aortic stenosis (AS) may rarely present like acute coronary syndrome with increased cardiac biomarker despite having normal coronaries. Here we describe a case of very severe AS, who presented with exertional and rest angina and a high level of TnI. Angiography revealed normal coronaries. Echocardiography showed very severe AS with peak velocity of 5.08\u2009m\/s and maximum and mean gradient of 103 and 54\u2009mm Hg, respectively. The patient subsequently underwent aortic valve replacement (AVR) successfully. Subendocardial ischaemia may occur in patients with severe AS during haemodynamic stress, even in the setting of normal unobstructed coronaries due to supply-demand mismatch. Subsequent degeneration and death of the cardiac myocytes cause cTnI elevation, which anticipates the start of the clinical downhill course in severe AS. Our case highlights the importance of thorough physical examination and early use of echocardiography in patients with angina to detect the presence of severe AS.<\/jats:p>","DOI":"10.1136\/bcr-2021-244627","type":"journal-article","created":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T12:01:40Z","timestamp":1640260900000},"page":"e244627","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Very severe aortic stenosis masquerading as acute coronary syndrome"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6441-645X","authenticated-orcid":false,"given":"Soumitra","family":"Ghosh","sequence":"first","affiliation":[{"name":"Department of Cardiology, PGIMER, Chandigarh, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7606-5826","authenticated-orcid":false,"given":"Akash","family":"Batta","sequence":"additional","affiliation":[{"name":"Department of Cardiology, PGIMER, Chandigarh, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yash Paul","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2420-5209","authenticated-orcid":false,"given":"Prashant","family":"Panda","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,12,23]]},"reference":[{"key":"2025082707024627000_14.12.e244627.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.011201"},{"key":"2025082707024627000_14.12.e244627.2","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1253\/jcj.65.839","article-title":"Microvascular angina in a patient with aortic stenosis","volume":"65","author":"Kawamoto","year":"2001","journal-title":"Jpn Circ J"},{"key":"2025082707024627000_14.12.e244627.3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4061\/2010\/423465","article-title":"A case of critical aortic stenosis masquerading as acute coronary syndrome","volume":"2010","author":"Wayangankar","year":"2010","journal-title":"Cardiol Res Pract"},{"key":"2025082707024627000_14.12.e244627.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.03.002"},{"key":"2025082707024627000_14.12.e244627.5","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht513"},{"key":"2025082707024627000_14.12.e244627.6","first-page":"I19","article-title":"Alterations in the coronary circulation in hypertrophied ventricles","volume":"75","author":"Marcus","year":"1987","journal-title":"Circulation"},{"key":"2025082707024627000_14.12.e244627.7","first-page":"157","article-title":"Two cases of acute myocardial infarction in patients with severe aortic stenosis and normal coronary arteries","volume":"5","author":"Abubakar","year":"2019","journal-title":"ACI"},{"key":"2025082707024627000_14.12.e244627.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-5273(02)00502-8"},{"key":"2025082707024627000_14.12.e244627.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(01)01501-6"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-244627","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T14:02:51Z","timestamp":1756303371000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-244627"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":9,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12,23]]},"published-print":{"date-parts":[[2021,12]]}},"alternative-id":["10.1136\/bcr-2021-244627"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-244627","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]}}}