Aortic Stenosis

Bottleneck

Step 1: View clinicals

A 68 year old man is referred for evaluation of a heart murmur discovered at a routine checkup. Initially, he claims to be asymptomatic. However, further questioning reveals a slight decrease in exercise capacity which he attributes to "old age". His medical and drug histories are unremarkable.


Step 2: Order all relevant investigations

ECG

The ECG appears normal.

Chest X ray

The x-ray appears normal.

Echocardiography

There is moderate aortic stenosis with an increased transvalvular pressure gradient and decreased transaortic flow velocity. Left ventricular hypertrophy is noted, while the ejection fraction is 60%.

Coronary Angiography

Coronary angiography shows a pristine coronary vasculature, with a right dominant circulation.


Step 3: Select appropriate management

Statins
Aspirin
Aortic Valve Replacement
Endocarditis Prophylaxis


Score: ★★☆