Syncope in Aortic Stenosis: Not Always What It Seems

Aortic stenosis is a common valvular pathology and may also have atypical presentations outside the classic triad of chest pain, syncope, and shortness of breath. Some patients may not present with the symptoms of the triad. This patient instead presented with syncope and vomiting. Statistically, the most common cause of syncope at rest in the setting of aortic stenosis is due to an arrhythmia rather than the valve itself limiting cardiac output. In a comorbid Alzheimer's patient who has developed hyperorality, postprandial hypotension can also result in syncope at rest. Therefore, syncope at rest should raise alarm for nonvalvular etiologies such as arrhythmia. This case study also aims to establish an association between syncope at rest and hyperorality in the setting of aortic stenosis, a first study so far. Additionally, it highlights an unusual presentation of aortic stenosis where syncope occurs at rest associated with vomit in the absence of chest pain or shortness of breath.