asymptomtic pt with AS ---------------what next - bloom

[ArchivalUser]

58 yrs old pt with Asymptomatic significant Aortic stenosis. what to do

A. Recommend aortic valve replacement.
B. recommend Aortic valcostomy.
C. tx with medication.
D. Leave as is.

[ArchivalUser]

u dont need to do surgery unless he is symptomatic OR unless the size of the orfice is less than .5cm.

sos i wud go with leave as is and do followup.

maybe u shud give diuretics but to contral chf symptomms but that too wud be risky because alraedy his cardiac output wud be less.

so i wud do D

i wud do A---if after a exercise test, if he gets symptoms and signs

...whats the answer.

[ArchivalUser]

uw says opposite.

* Aortic stenosis tx -- Aortic valve replacement is preferred. Aortic valvostomy is considered in hemodynamically unstable pt, or for poor surgical candidate.
* Indication for Aortic replacement ---- 1. All symptomatic pt with Aortic stenosis.
2. Pt with severe Aortic stenosis undergoing CABG or other valvular surgery.
3. Asymptomatic pt with severe aortic stenosis or either poor LV systolic function, LV hypertrophy (>15mm),
valve area < 0.6 cm2, or abnormal response to exercise.

[ArchivalUser]

so its not opposite...is this patient u gave symptomatic if he isnt symptomatic...then u dont do anythign

thats what i said up there....what did i say wrong.

[ArchivalUser]

by the way, thanks for the murmur links bloom. that is a great site..

[ArchivalUser]

the pt is asymptomatic with significant aortic stenosis.

ASYMPTOMATIC need aortic replacement.

the severity is in asymptomatic pt is evaluate with echo.

[ArchivalUser]

agreed. i didnt know significant---u meant that he has a small orfice..oh i was loooking for some values..ok got it..