Eventually, however, the heart muscle will require more blood supply at rest than can be supplied by the coronary artery branches. At this point there may be signs of ventricular strain pattern (ST segment depression and T wave inversion) on the EKG, suggesting subendocardial ischemia.

The most recent guidelines from the American Heart Association (AHA) recommend offering electrocardiography to all patients with suspected aortic stenosis. 14 This may show left ventricular hypertrophy and evidence of left axis deviation (fig 3 ⇓).