Severe Aortic Stenosis Concealed by a Negative History in Pregnancy: A Case Report Emphasizing the Diagnostic Cornerstones of History and Physical Examination

Milad  Masaeli; Shamin  Ghobadi; Mohammad Kazem Rezaei  Hoseinabadi

doi:10.18502/crcp.v10i4.21108

Milad Masaeli Water and Electrolyte Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Shamin Ghobadi Department of Gynecology and Obstetrics, Faculty of medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Mohammad Kazem Rezaei Hoseinabadi Department of Anesthesiology, Chamran Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

DOI: https://doi.org/10.18502/crcp.v10i4.21108

Keywords: Anesthesia; Obstetrical; Cardiopulmonary arrest

Abstract

Pregnancy concurrent with severe underlying cardiac disease presents a substantial risk to maternal and fetal well-being. Despite routine antenatal screening, patients may occasionally deny or be unaware of critical cardiac histories, complicating perioperative management and leading to catastrophic decompensation. We report the case of a 22-year-old primigravida admitted for labor with intrauterine fetal demise (IUFD). The initial history was non-contributory, and the physical examination was unremarkable. Following an uncomplicated delivery and regional analgesia, the patient experienced sudden hemodynamic collapse, seizure, and pulmonary edema, necessitating emergent intubation and intensive care. Subsequent echocardiography revealed previously undiagnosed severe aortic stenosis (AS) with a mean pressure gradient of approximately 100 mmHg. This case highlights how severe, compensated pathology can be masked by patient denial, underscoring the indispensable role of a meticulous history and physical examination as the primary diagnostic tool in obstetric anesthesia, regardless of self-reported symptoms