Aortic stenosis: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
*Echocardiography, transthoracic | *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== | ==Differential Diagnosis== | ||
Revision as of 16:09, 6 February 2015
Background
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
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
Source
Tintinalli