0071643192.pdf

SYMPTOMS

■ Theclassic triadof symptomatic aortic stenosis is dyspnea on exertion
(CHF), chest pain, and syncope.
■ Sudden death from dysrhythmias or acute onset of failure may occur.

EXAM

■ Crescendo-decrescendo systolic murmur radiating to the neck
■ Paradoxically split S2
■ Narrowed pulse pressure due to drop in systolic BP
■ Low amplitude (parvus) and slow rising (tardus) carotid pulse
■ Brachioradial delay
■ Pulmonary edema if severe AS

DIAGNOSIS

■ ECG:LVH with strain, left bundle branch block
■ CXR:LVH, pulmonary congestion (if CHF is present)
■ Echocardiography:Confirms the diagnosis, allows measurement of valve
area

TREATMENT

■ Treat CHF with gentle diuresis.
■ Rule out ACS in acute presentations.
■ Hydrate gently for hypotension.
■ Avoid
■ Preload or afterload reducers (no nitroglycerin)
■ Negative inotropes
■ These may cause acute decompensation and severe hypotension.
■ Prophylaxis for endocarditis
■ Definitive treatment is valve replacement.

Aortic Regurgitation (Aortic Insufficiency)

Aortic regurgitation (AR) may be acute or chronic. It is important to make
this differentiation as acute aortic regurgitation is a surgical emergency requir-
ing immediate valve replacement.

ETIOLOGIES

■ Acute aortic regurgitation
■ Infective endocarditis
■ Aortic dissection with proximal extension
■ Trauma
■ Chronic aortic regurgitation
■ Rheumatic heart disease
■ Bicuspid aortic valve
■ Dilation of the aortic root (Marfan, ankylosing spondylitis, rheumatoid
arthritis)

PATHOPHYSIOLOGY

■ Acute aortic valve failure→rapid rise in LV diastolic pressure →acute
pulmonary edema and cardiogenic shock
■ Chronic aortic valve failure →compensatory LVH, gradual left ventricular
dilation →gradual onset of heart failure symptoms

CARDIOVASCULAR EMERGENCIES

Classic triad of symptomatic

aortic stenosis:

Dyspnea, chest pain, and

syncope

Avoid nitrates in the treatment

of aortic stenosis since they

may lead to severe

hypotension refractory to

therapy.

Acute aortic regurgitation?

Consider endocarditis, aortic

dissection, and trauma.

Acute aortic regurgitation is a

surgical emergency.