4. Which of the following patients with aortic valve stenosis will be most likely to have angina based on increased oxygen demand from high wall stress?

A. Septal/posterior wall thickness 1.0 cm, left ventricular end-diastolic dimension 4.0 cm, left ventricular end diastolic pressure 15 mmHg.

B. Septal/posterior wall thickness 1.5 cm, left ventricular end-diastolic dimension 4.5 cm, left ventricular end diastolic pressure 10 mmHg.

C. Septal/posterior wall thickness 1.5 cm, left ventricular end-diastolic dimension 5.0 cm, left ventricular end diastolic pressure 20 mmHg.

D. Septal/posterior wall thickness 1.0 cm, left ventricular end-diastolic dimension 5.5 cm, left ventricular end diastolic pressure 10 mmHg.

Recall the Law of Laplace:

 

LaPlace

When analyzing the above four choices, then scenario that results in the highest wall stress is choice C. Simply plug the numbers into the above equation and choice C will yield the highest result. Remember wall stress is directly proportional to LV pressure and radius and inversely proportional to two times the wall thickness.