Introduction: Patients with symptomatic severe aortic valve stenosis (AS) experience short and long-term survival benefit with aortic valve replacement (AVR). Among patients with asymptomatic severe AS (ASAS) current guidelines recommend exercise stress testing (ETT) as a safe and effective method to risk stratify patients and to assist with the timing of AVR. We discuss the course of disease in AS, review the role of ETT and express concerns about the safety of performing stress tests in asymptomatic patients with severe AS.

Case Report: We describe the case of a 69-year-old male with left bundle branch block and ASAS who underwent ETT with echocardiographic imaging. We describe the details of the patient's clinical, ECG and echo doppler parameters prior, during and following the test. Patient developed pulseless electrical activity during early recovery with eventual resuscitation and mechanical support. The patient did not survive due to continued deterioration in clinical status.

Conclusion:Despite being considered safe, ETT can unmask symptoms in ASAS and result in hemodynamic instability leading to death. A comprehensive registry of safety data is needed. Clinical vigilance and physician supervision during stress testing may minimize the risk of serious adverse events.

Keywords: Asymptomatic severe aortic stenosis, Exercise treadmill testing, Mortality, Safety