We retrospectively reviewed the clinical and hemodynamic findings in 397 patients with valvular aortic stenosis at their first hemodynamic evaluation. This series is considered representative of aortic stenosis because it is heavily weighted toward older patients (average age, 61.1 years) and severe aortic stenosis (87.3% of patients had aortic valve area less than 1 cm2). We identified two categories of symptoms: angina and syncope, which develop during a fully compensated stage of aortic stenosis ("prefailure symptoms"); and dyspnea or congestive failure, which signifies various degrees of left ventricular malfunction. The preponderance of soft or medium intensity systolic murmur and normal or widened pulse pressure emphasizes the changing clinical picture of aortic stenosis in an aging population. Coexisting coronary artery disease was found in 60% of patients, but those with and without coronary disease did not differ significantly, even in the presence of angina.