Hey everyone,

I recently had a 76yr old pt who had severe AS with an annulus of 0.7 which was idiopathic. Medical problems included DM type II, hypertension, hyperlipidemia, hypothyroidism, and chronic Afib. Per her cath report she has normal EF of 55%, but her CO/CI were low. Her CI was around 1.7 to 1.9. So, my question is, how can a person have such severe AS with normal EF but low CO/CI? There was no AI as well. She was not tachycardic, and her BP was controlled with her medications. She had a normal LV size and all her coronaries were clear of any calcification or blockage. She was not on a beta blocker either. I understand if she had AI, the regurg could cause a lower CO/CI, but she was negative for that. And I also understand EF is LV ejection fraction with each beat and CO/CI is output per min.

the only thing I can think of, in my own head, is that her delayed output with her severe AS could still result in normal EF but since her EF would be slower than a person with a normal AV valve it would result in less output per min showing a lower CO/CI? I have no idea if im thinking of this in the correct way or not? I have just started my cardiac rotation and this is one of the questions that came to me after clinical.

Thanks in advance,
Nate