SAD
Aortic Stenosis Classic Triad
Three symptoms — each signals worse prognosis than the last.
Clinicians lean on this acronym when a systolic murmur radiates to the carotids and the next question is how symptomatic the patient is. SAD — Syncope, Angina, Dyspnea — is the classic aortic stenosis symptom triad, and each carries progressively worse prognosis: median survival without valve replacement is roughly 5 years for angina, 3 years for syncope, and 2 years for heart failure once symptoms begin. AANP exam vignettes use SAD to test referral timing — symptomatic severe AS is a surgical referral, not a follow-up. Asymptomatic patients with peak velocity over 4 m/s or mean gradient over 40 mmHg also warrant cardiology evaluation for valve replacement timing.
- SSyncopeOn exertion. Fixed cardiac output can't meet demand. ~3-year median survival without valve replacement.
- AAnginaIncreased myocardial demand + reduced coronary perfusion. ~5-year median survival.
- DDyspneaOnset of heart failure. Worst prognosis — ~2-year median survival.
Clinical Context
Classic triad of symptomatic severe aortic stenosis. Each symptom carries a distinct prognosis — dyspnea (heart failure) is the most ominous. Any symptom in a patient with severe AS is an indication for valve replacement (SAVR or TAVR).
AANP pairs a stem with a harsh crescendo-decrescendo systolic murmur at the RUSB radiating to the carotids + one of these symptoms → diagnosis of severe AS + recommendation for valve intervention. Asymptomatic severe AS is typically watched; symptomatic = fix.
Related Mnemonics
- 5 T's — Cyanotic Congenital Heart Defects
- 6 P's — Acute Limb Ischemia
- CHA₂DS₂-VASc — Stroke Risk in Non-Valvular Atrial Fibrillation
- HAS-BLED — Bleeding Risk on Anticoagulation
- MR. PASS MVP — Systolic Murmurs
Sources
Ready to practice?
1,500+ AANP-style questions with rationales — free trial.