Aortic stenosis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Dyspnea, CP, syncope | *Dyspnea, CP, syncope | ||
**Once symptoms present mean | **Once symptoms present mean survival is 2-3yr | ||
*ejection systolic murmur radiating to carotids | *ejection systolic murmur radiating to carotids | ||
*Pulsus parvus et tardus, slow to rise and late peaking | *'Pulsus parvus et tardus', slow to rise and late peaking | ||
*Narrowed pulse pressure | *Narrowed pulse pressure | ||
*Soft 2nd heart sound | *Soft 2nd heart sound | ||
| Line 25: | Line 25: | ||
**>4.0 = severe | **>4.0 = severe | ||
== | ==Management== | ||
*Avoid negative inotropes such as BBs, CCBs | *Avoid negative inotropes such as BBs, CCBs | ||
*Afterload reduction is controversial and in decompensated AS should only be conducted in a monitored setting | *Afterload reduction is controversial and in decompensated AS should only be conducted in a monitored setting | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Cards]] | [[Category:Cards]] | ||
Revision as of 10:06, 21 February 2016
Background
Clinical Features
- Dyspnea, CP, syncope
- Once symptoms present mean survival is 2-3yr
- ejection systolic murmur radiating to carotids
- 'Pulsus parvus et tardus', slow to rise and late peaking
- Narrowed pulse pressure
- Soft 2nd heart sound
Differential Diagnosis
Valvular Emergencies
Diagnosis
- Echocardiography, transthoracic
- This will typically demonstrate minimal excursion of the aortic valve leaflet
- Continuous wave doppler across the aortic valve with typically demonstrate high velocities
- Color doppler will demonstrate turbulent flow across the valve
- The left ventricle will demonstrate left ventricular hypertrophy
- Severity by CW Doppler velocity (m/s)[1]
- Ensure parallel intercept angle across aortic valve in apical view
- <2.5 = aortic sclerosis
- 2.6 - 2.9 = mild
- 3.0 - 4.0 = moderate
- >4.0 = severe
Management
- Avoid negative inotropes such as BBs, CCBs
- Afterload reduction is controversial and in decompensated AS should only be conducted in a monitored setting
- Consider cards consult
- AS + A-fib = emergency
- Consider emergent cardioversion
- Pulm edema
- Diuretics, NIV, and intubation if necessary
- Extreme caution with use of nitrates/vasodilators (preload reducers)
- In critical cases, particularly in those unstable to undergo emergent surgery, balloon aortic valvuloplasty may be an option as bridge to AVR or palliative care in nonsurgical candidates
Disposition
- Severe HF symptoms resistant to medical management require urgent surgery
- Class I indications for AVR:
- Severe AS in symptomatic pt
- Severe AS undergoing CABG, aortic, or valve surgery
- Severe AS with LV dysfunction, EF < 50%
See Also
References
- ↑ Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, Iung B, Otto CM, Pellikka PA, Quiñones M, American Society of Echocardiography, and European Association of Echocardiography. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009 Jan;22(1):1-23; quiz 101-2.