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Aortic Stenosis

-referred to the narrowing of the aortic valve opening
-3 main causes: congenital abnl resulting in unicuspid or bicuspid valve, age-related calcification, and rheumatic fever
– Worldwide, rheumatic heart disease is most common
-US, age related calcification and congenital biscuspid valve are most common

Signs and symptoms
-transient loss of consciousness, difficulty breathing, syncope, dizziness, and angina with exertion due to reduced blood flow from the heart.

Physical Exam
-systolic crescendo-decrescendo murmur heard in the intercostals space between ribs 2 and 3 that radiates to the carotid arteries.

Complications
-aortic stenosis can develop into abnormal heart rhythms including A-fib, V-tach, bradycardia leading to sudden cardiac death.
-Patients also at risk for developing endocarditis
-Other risks include formation of blood clots in major blood vessels of the brain and body

Diagnostic tests
-EKG – evaluates rate and rhythm of the heart
-Echocardiogram – to evaluate structural integrity of the heart’s valves and to check blood flow.
-CT or MRI of the aorta may be necessary if ECHO is inconclusive
Cardiac cath – may be warranted to measure flow of blood through the valve

 

Management
-asymptomatic patients – may be advised to avoid strenuous sports and exercise
-medications can be utilized to manage symptoms of aortic stenosis but do not prevent the progress of valvular disease. However, medical therapy is useful in managing coexisting conditions that correlate with aortic stenosis:
-BBs, CCBs, and/or nitrates may be useful in treat coexisting hypertension
-Digoxin and diuretics may be useful in treating coexisting congestive heart failure

-prophylactic antibiotics currently not recommended for prevention of infective endocarditis in patients who undergo dental procedures.
-survival of patients with aortic stenosis dramatically decreases once patients develop symptoms of angina, syncope, or heart failure.

-According to the American College of Cardiology and American Heart Association, it is recommended to have the valve replaced in patients who are asymptomatic but have a reduced ejection fraction of <50%, measured on echocardiogram. Other factors considered for valve replacement include likelihood of aortic stenosis progression which factors in age, calcification, and coronary artery disease. The severity of stenosis based on specific valve dimensions and an abnormal stress test can also play a role in the deciding whether to have the aortic valve replaced.
-Aortic valve replacement is recommended for patients who develop symptoms and is considered most effective in improving survival. Aortic valve replacement can be replaced surgically or trans-catheter implantation. Tran-catheter implantation repairs the aortic valve without removing the old, damaged valve.

 

Dr. Ben- Zur is an elctrophysiologist and board certified cardiologist in the Burbank area who can help diagnose and treat valvular diseases like aortic stenosis. Here at the Cardiovascular institute we also perform replacements, pacemaker implantation, stress tests, electrocardiograms and various other procedures in our state of the art facilities.

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