Cardiology Question 35 Instructor

What is the management of patients with aortic stenosis (symptomatic and asymptomatic)?

Aortic stenosis (AS) patients who are asymptomatic should be followed clinically and by echocardiogram. The ACC/AHA guidelines [1] recommend asymptomatic AS patients to have serial echocardiographic testing with the following time intervals:

  • Severe AS: every year
  • Moderate AS: every two years
  • Mild AS: every five years

Echocardiograms should be performed whenever there is an important change in clinical symptoms or findings.

Indications for aortic valve replacement for aortic stenosis include:

  1. Angina
  2. Congestive Heart Failure (CHF)
  3. Syncope or presyncope
  4. Episode of aborted sudden death

If a stenotic valve is not replaced, approximately 50% of patients will be dead:

  1. Within 5 yrs after angina develops
  2. Within 3 yrs after exertional syncope develops
  3. Within 2 yrs after heart failure develops

Symptoms are usually associated with:

  • aortic valve area (AVA) >0.8 cm2
  • and/or transvalvular mean gradient >50 mmHg.

Patients often exhibited symptomatic improvement and increased in survival after AVR.

Nishimur RA, et al. ACC/AHA 2014 practice guidelines for the management of patients with valvular heart disease: executive summary. JACC 2014 Jun 10;63(22):2438-88

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