The classic triad of symptoms for a valvular disease is abbreviated ASH. Which three features are included?

• A. Angina, Syncope, Heart Failure
• B. Arrhythmia, Shortness of Breath, Hypertension
• C. Abdominal Pain, Syncope, Fever
• D. Anaerobic, Shock, Hyperkalemia

Answer: (A)

The main idea here is recognizing the classic symptom trio that signals significant aortic stenosis. When a valve is narrowed, the outflow from the left ventricle is obstructed, so the heart can’t increase its output with exercise. That fixed output leads to three characteristic problems: Angina from the mismatch between higher myocardial oxygen demand and limited supply; Syncope during exertion due to transient insufficient cerebral perfusion; and Heart Failure symptoms as the ventricle hypertrophies under pressure and eventually decompensates. The other options mix symptoms or problems that aren’t the familiar triad seen with this valvular disease. So the three features in this context are Angina, Syncope, and Heart Failure.