Day #112 - Severe Aortic Stenosis

I hope that you enjoyed today's case. The discussant took us through an excellent classification and approach to congestive heart failure. We then unfortunately ran out of time part way through the best part -- which was the management options, including new and exciting interventional techniques for severe aortic stenosis.

Approach to Etiologies of CHF:

• Arrythmia -- either too fast or too slow
  
• Valvular -- aortic stenosis/regurgitation, mitral regurgitation/stenosis, less likely pulmonic and tricuspid stenosis/regurgitation
  
• Pericardial disease -- tamponade, constrictive pericarditis
• Myocardial disease -- toxins (like chemotherapy), infiltration/restriction (i.e amyloid), genetic (hypertrophic cardiomyopathy), idiopathic/infectious, hypertension with LVH (diastolic dysfunction)
• Ischemia -- either old ischemia and infarcts or acute ischemia
• High output -- severe anaemia, paget's disease of bone, arteriovenous malformations

Aortic Stenosis (is a SADD disease):

When symptomatic it can present with:

• S - Syncope
• A - Angina
• D - Dyspnea (CHF)
• D - Death

Survival in patients with symptomatic severe aortic stenosis is poor without valve replacement surgery

The ACC recommendations for valve replacement are summarized below:


In patients who can't have valve replacement the options include:

• Palliation
• Maximal medical therapy (symptomatic)
• Interventional - Valvuloplasty (palliative) or percutaneous valve replacement
  

I have previously blogged about congestive heart failure here and briefly discussed cardiomyopathy here.
I have previously blogged about the Jugular venous pressure and its waveforms here