Learning on the Web. Case 1: syncope and palpitation in a patient following aortic valve replacement.

A usually very fit man aged 90 presented with syncope and angina of effort. He was found to have severe calcific aortic stenosis and associated coronary disease restricted to the left anterior descending (LAD) coronary artery. He underwent an aortic valve replacement with tissue prosthesis and a single coronary graft to the LAD. He came off bypass without difficulty but on the third postoperative period, when he had left the intensive care unit and was making excellent progress mobilising, he had further episodes of syncope and also developed palpitations. The significance of these symptoms and the diagnosis and treatment of these postoperative problems is discussed in an interactive case presentation.