q2 - darkhorse

[ArchivalUser]

yes...

[ArchivalUser]

9: b
Aortic stenosis is the most common
cardiac valvular disorder secondary to
the high rate of congenital bicuspid aortic
valves as well as the aging of the general
population. The murmur of AS is
described as a crescendo-decrescendo
systolic murmur best heard at the upper
right sternal border radiating to the
MAINTAINING CERTIFICATION IN CARDIOLOGY
carotids. As the valve area decreases
from the normal 3-4 cm2 to the critical <
1 cm2, the mean pressure gradient increases
exponentially. This increase in
the pressure gradient causes the peak of
the murmur to occur later in systole
often accompanied by a soft S2. An early
or mid-peaking murmur usually signifies
noncritical AS. Aortic valve replacement
is the only treatment for severe, symptomatic
AS. The risk of surgery must be
weighed against the risk of delay. Of the
35% of patients with AS who present
with angina, 50% will die within 5 years
if the valve is left unreplaced. Of the 15%
who present with syncope, 50% will die
within 3 years. And, of the 50% who
present with dyspnea secondary to heart
failure, 50% will die within 2 years.
Therefore it is imperative to replace all
critical valves in symptomatic patients if
possible. Stress echocardiography is contraindicated
in patients with severe or
symptomatic AS. But in patients with
moderate-to-severe asymptomatic AS,
stress echocardiography can help to identify
patients at increased risk who would
benefit from early valve replacement. All
patients who are scheduled for CABG
should be evaluated for AS, and concomitant
aortic valve replacement
should be performed if present, even if
the valve area is not yet critical.



Carabello BA. Clinical practice: aortic stenosis.
N Engl J Med. 2002;346:677-682.