Daily Bolus of LR: Aortic Stenosis

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January 20, 2012 by dailybolusoflr

Aortic Stenosis

 

·         The most common cause is calcific degeneration, most commonly in older patients

·         Younger patients are more likely to have a bicuspid valve

·         Normal valve diameter is 3 cm2

·         Significant obstruction occurs when the diameter is less than 50% and critical AS when the diameter is less than 0.8 cm2  or when the pressure gradient across the valve exceeds 50 mm Hg

·         Patients compensate up to a point with the development of LVH, then left atrial enlargement

o   These patients often develop atrial fibrillation related to the left atrial enlargement

·         Patients are preload dependent and have little reserve when they have critical disease

·         Classic symptoms of aortic stenosis:

o   Angina

o   Exertional syncope

o   Congestive heart failure

·         PE

o   Crescendo-decrescendo murmur heard best at the base and radiates into carotids

§  As disease gets worse, murmur peaks later and actually becomes less noticeable

o   Carotid: parvus et tardus (delayed and diminished)

·         Management

o   Maintenance of pre-load (use of IVF; avoidance of nitrates, getting patients out of afib)

o   Intra-aortic balloon pump in decompensated shock as bridge to surgery, which is the definitive management

 

Ref: Rosen’s 7th ed

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