Aortic Stenosis Flashcards
MCC of AS
progressive calcification of normal trileaflet valve
usual age of dx of AS
60 yoa or more
when do pts w/ congenital bicuspid aortic valve usually present?
40-60 yoa
cardinal sxs of AS
- HF
- angina
- syncope
heart sound/murmur heard in AS
- midsystolic murmur at upper right 2nd ICS
- murmur radiates to carotid arteries
- decreased intensity of S2
carotid pulse in AS
delayed, low-amplitude (pulsus parvus et tardus)
CXR findings in AS
- boot-shaped cardiac silhouette
- poststenotic aortic dilatation
echo findings in AS
- LAE
- LVH
- calcified aortic valve leaflets w/ restricted motion
SEVERE AS a/w valve area and mean transvalvular gradient of?
- < 1 cm2
- > 40 mmHg
AS in setting of GIB (rare)
Heyde syndrome
pathophysiology of Heyde syndrome
acquired vWD
DON’T BE TRICKED
when is transvalvular gradient significantly UNDERestimated?
decreased LV function
DON’T BE TRICKED
when should you avoid an EST in a pt w/ AS?
symptomatic AS
treatment of choice for most pts w/ symptomatic severe AS
surgical aortic valve replacement
when is transcatheter aortic valve replacement (TAVR) the tx of choice?
HIGH-risk pts who are NOT surgical candidates
CONTRAINDICATIONS to TAVR
- bicuspid aortic valve
- significant AR
- mitral valve dz
tx for AS until surgery or TAVR
diuretics, digoxin, ACEI, +/- nitrates (may not tolerate)
DON’T BE TRICKED
what tx should NOT be done for AS?
balloon valvuloplasty
DON’T BE TRICKED
what med should NOT be given to pts w/ AS and HF?
BB
DON’T BE TRICKED
what medication does NOT change the natural h/o AS?
statins
how often to get echos in Asymptomatic pts w/ SEVERE AS?
yearly
how often to get echos in Asymptomatic pts w/ MODERATE AS?
every 1-2 years
how often to get echos in Asymptomatic pts w/ MILD AS?
every 3-5 years
