Dr. Lindower
February 2017
R2 Talk: Dr. Emily Nguyen, MD, PhD
Mentor: Dr. Milena Gebska, MD, PhD
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Aortic Stenosis
Definition: Valvular aortic stenosis is a progressive disease in which the end stage is characterized by obstruction of left ventricular outflow, resulting in inadequate cardiac output, decreased exercise capacity, heart failure, and death from cardiovascular causes.
Typical Symptoms:
* Angina
* Dyspnea on exertion
* Syncope
* Heart Failure
Risk Factors:
* Hypertension
* Diabetes
* Dyslipidemia
* AGE – 9.8% in octogenarians
Severe AS can be diagnosed on physical exam:
* Typical systolic ejection murmur at the base radiating to the neck
* Usually peaks in early- or mid-systole
* Carotid pulse is delayed “parvus et tardus”
* Absent or soft S2
Transcatheter Aortic Valve Replacement:
* Non-invasive intervention for valve replacement
* Adverse events include: conduction abnormalities (LBBB, heart block), stroke, vascular complications, acute renal failure, paravalvular leak
References:
1. Otto CM, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021 Feb 2;143(5):e72-e227. doi: 10.1161/CIR.0000000000000923. PMID: 33332150.
2. Ross J Jr, Braunwald E. Aortic stenosis. Circulation. 1968 Jul;38(1 Suppl):61-7. doi: 10.1161/01.cir.38.1s5.v-61. PMID: 4894151.
