Internal Medicine

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

1510 Vaginitis Valvular Heart Disease Aortic Stenosis (AS)

➣For persistent/recurrent symptoms, re-examine and repeat ther-

apy with longer course of topical therapy, different topical agent

or oral therapy if topical originally used; consider infection with

non-albicans candida

➣Consider treatment of sexual partner; review hygiene

➣For recurrent VVC (defined as≥4 episodes of symptomatic dis-

ease per year), screen for diabetes and HIV; consider gynecolog-

ical referral and long-term antifungal suppression therapy

■Trichomoniasis

➣Treatment with Metronidazole results in cure rates of 90–95%

➣Recurrent infections caused by organisms with decreased sus-

ceptibility to Metronidazole can usually be treated with higher

doses

➣Associated with premature rupture of membranes and preterm

delivery but routine screening in pregnancy not generally rec-

ommended

VALVULAR HEART DISEASE AORTIC STENOSIS (AS)

JUDITH A. WISNESKI, MD

history & physical

Etiology

■Congenital bicuspid aortic valve (develops AS ages 40–60; more com-

mon in males)

■Senile calcified (normal 3 – leaflet valve; AS ages 70–80)

■Rheumatic heart disease (abnormality of mitral valve present)

■Congenital AS

History

■Symptoms of pulmonary congestion: PND, DOE or orthopnea (due

to left ventricular (LV) diastolic impairment or systolic dysfunction)

■Angina (may be related to LV hypertrophy alone, or in combination

with CAD)

■Syncope/near-syncope – usually associated with exertion (due to

limited cardiac output secondary to aortic valve obstruction, vasode-

pressor response, or stress induced arrhythmia)

Signs & Symptoms

■Systolic murmur radiates to the right supraclavicular fossa

➣Mild to moderate AS: Murmur peaks early in systole