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

Differential Diagnosis

Valvular Emergencies

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

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.

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
• Cardiogenic shock