Aortic stenosis

Clinical Features

• Dyspnea, CP, syncope
  • Once symptoms present mean surival 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

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.

Differential Diagnosis

Valvular Emergencies

• Mitral stenosis
• Mitral regurgitation
  • Mitral valve prolapse
• Aortic stenosis
• Aortic regurgitation

Treatment

• Admission
• 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, intubation if necessary
  • Extreme caution with use of nitrates/vasodilators

• In critical cases, particularly in those unstable to undergo emergent surgery, balloon aortic valvuloplasty may be an option.

See Also

• Valvular emergencies
• Heart murmurs

Source

Tintinalli