Internal Medicine

0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23

1512 Valvular Heart Disease Aortic Stenosis (AS)

Exercise Testing

■Severe AS – Do not perform exercise test

■Mild AS with vague symptoms – perform cautiously under guidance

of trained physician

differential diagnosis

■Idiopathic hypertrophic subaortic stenosis

■Discrete subaortic stenosis

■Supravalvular aortic stenosis

■Subclavian arterial bruit

■Pulmonic valvular stenosis

■Dilated aorta with systolic murmur

■Mirtal regurgitation

management

Medical Treatment

■Antibiotic prophylaxis for all patients (asymptomatic included)

■Therapy for angina and congestive heart failure(Use medical ther-

apy cautiously – medication may mask symptoms)

Surgical Treatment

■Aortic valve replacement (AVR) only effective treatment to improve

survival in adults

■Indications for AVR:

➣Symptomatic (angina, syncope or congestive heart failure – aortic

valvearea(AVA)<or=0.75 cm2; AVA may be 1.0 cm2 with CAD)

■Mechanical versus bioprosthetic AVR:

➣Mechanical AVR – requires warfarin, but more durable

➣Bioprosthetic AVR – older patients and patients not able to tol-

erate warfarin

Palliative Treatment

(co-morbidity prohibits AVR)

■Aortic balloon valvotomy may relieve symptoms (does not change

overall mortality; survival without restenosis <50% at 1 year)

■Treatment for CHF may temporarily improve symptoms

specific therapy

n/a

follow-up

n/a