Aortic stenosis: Difference between revisions
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==Background== | ==Background== | ||
*Younger patients: usually from a congenital bicuspid valve | |||
*Older patients: usually from calcifications on aortic valve | |||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 14:44, 16 August 2016
Background
- Younger patients: usually from a congenital bicuspid valve
- Older patients: usually from calcifications on aortic valve
Clinical Features
- Dyspnea, chest pain, 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
Evaluation
- 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 beta-blockers, calcium-channel blockers
- Afterload reduction is controversial and in decompensated AS should only be conducted in a monitored setting
- Consider cardiology consult
- AS + A-fib = emergency
- Consider emergent cardioversion
- Pulmonary 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.