Aortic stenosis - Revision history

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2026-03-22T09:59:12Z

Add peer-reviewed references with PMIDs

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	==Clinical Features==		==Clinical Features==
	[[File:Phonocardiograms from normal and abnormal heart sounds.svg\|thumb\|Phonocardiograms of common cardiac murmurs.]]		[[File:Phonocardiograms from normal and abnormal heart sounds.svg\|thumb\|Phonocardiograms of common cardiac murmurs.]]
	*[[Dyspnea]], [[chest pain]], [[syncope]]		*[[Dyspnea]], [[chest pain]], [[syncope]]<ref>Nishimura RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease. J Am Coll Cardiol. 2014;63(22):e57-e185. PMID 24603191</ref>
	**Once symptoms present mean survival is 2-3yr		**Once symptoms present mean survival is 2-3yr
	**Natural history is [[angina]], then [[syncope]], then dyspnea from [[CHF]] which is late stage		**Natural history is [[angina]], then [[syncope]], then dyspnea from [[CHF]] which is late stage

2024-11-13T16:32:12Z

Clinical Features

← Revisión anterior		Revisión del 16:32 13 nov 2024
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	==Clinical Features==		==Clinical Features==
			[[File:Phonocardiograms from normal and abnormal heart sounds.svg\|thumb\|Phonocardiograms of common cardiac murmurs.]]
	*[[Dyspnea]], [[chest pain]], [[syncope]]		*[[Dyspnea]], [[chest pain]], [[syncope]]
	**Once symptoms present mean survival is 2-3yr		**Once symptoms present mean survival is 2-3yr

2024-11-13T16:31:23Z

Differential Diagnosis

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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Valvular emergencies DDX}}		{{Valvular emergencies DDX}}
			{{Congenital heart disease DDX}}

	==Evaluation==		==Evaluation==

2024-11-13T16:25:46Z

Background

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	==Background==		==Background==
	[[File:Blausen 0040 AorticStenosis.png\|thumb\|Drawing of aortic stenosis.]]		[[File:Blausen 0040 AorticStenosis.png\|thumb\|Drawing of aortic stenosis.]]
			[[File:Aortic stenosis rheumatic, gross pathology 20G0014 lores.jpg\|thumb\|Severe stenosis due to rheumatic heart disease in a pathology specimen.]]
	*Younger patients: usually from a congenital bicuspid valve		*Younger patients: usually from a congenital bicuspid valve
	*Older patients: usually from calcifications on aortic valve		*Older patients: usually from calcifications on aortic valve

2024-11-13T16:24:02Z

Background

← Revisión anterior		Revisión del 16:24 13 nov 2024
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	==Background==		==Background==
			[[File:Blausen 0040 AorticStenosis.png\|thumb\|Drawing of aortic stenosis.]]
	*Younger patients: usually from a congenital bicuspid valve		*Younger patients: usually from a congenital bicuspid valve
	*Older patients: usually from calcifications on aortic valve		*Older patients: usually from calcifications on aortic valve

2021-09-16T22:24:57Z

Management

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	***[[Etomidate]] is the induction agent of choice		***[[Etomidate]] is the induction agent of choice
	**Extreme caution with use of nitrates/vasodilators (preload reducers)		**Extreme caution with use of nitrates/vasodilators (preload reducers)
			**Blood transfusions may cause flash pulmonary edema
	**[[IVF\|Fluid administration]] takes precedence over worsening pulmonary edema in order to increase preload in patients who are hypotensive		**[[IVF\|Fluid administration]] takes precedence over worsening pulmonary edema in order to increase preload in patients who are hypotensive
	*[[Vasopressors]]		*[[Vasopressors]]

2021-06-30T15:26:04Z

External Links

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	==External Links==		==External Links==
	*[[https://www.emra.org/emresident/article/the-crashing-patient-with-critical-aortic-stenosis/ EMRA: The Crashing Patient with Critical Aortic Stenosis]		*[https://www.emra.org/emresident/article/the-crashing-patient-with-critical-aortic-stenosis/ EMRA: The Crashing Patient with Critical Aortic Stenosis]
			*[http://www.emdocs.net/pocus-for-aortic-stenosis/ emDocs - Pocus for Aortic Stenosis]

	==References==		==References==

2021-03-14T21:49:37Z

Management

← Revisión anterior		Revisión del 21:49 14 mar 2021
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	*[[Pulmonary edema]]		*[[Pulmonary edema]]
	**[[Diuretics]], [[NIPPV\|NIV]], and [[intubation]] if necessary		**[[Diuretics]], [[NIPPV\|NIV]], and [[intubation]] if necessary
			***[[Etomidate]] is the induction agent of choice
	**Extreme caution with use of nitrates/vasodilators (preload reducers)		**Extreme caution with use of nitrates/vasodilators (preload reducers)
			**[[IVF\|Fluid administration]] takes precedence over worsening pulmonary edema in order to increase preload in patients who are hypotensive
	*[[Vasopressors]]		*[[Vasopressors]]
	**[[Phenylephrine]] is the vasopressor of choice<ref>Goertz AW, Lindner KH, Schutz W, Schirmer U, Beyer M, Georgieff M. Influence of phenylephrine bolus administration on left ventricular filling dynamics in patients with coronary artery disease and patients with valvular aortic stenosis. Anesthesiology. 1994;81(1):49-58.</ref>		**[[Phenylephrine]] is the vasopressor of choice<ref>Goertz AW, Lindner KH, Schutz W, Schirmer U, Beyer M, Georgieff M. Influence of phenylephrine bolus administration on left ventricular filling dynamics in patients with coronary artery disease and patients with valvular aortic stenosis. Anesthesiology. 1994;81(1):49-58.</ref>

2021-03-14T21:44:22Z

Management

← Revisión anterior		Revisión del 21:44 14 mar 2021
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	**[[Diuretics]], [[NIPPV\|NIV]], and [[intubation]] if necessary		**[[Diuretics]], [[NIPPV\|NIV]], and [[intubation]] if necessary
	**Extreme caution with use of nitrates/vasodilators (preload reducers)		**Extreme caution with use of nitrates/vasodilators (preload reducers)
			*[[Vasopressors]]
			**[[Phenylephrine]] is the vasopressor of choice<ref>Goertz AW, Lindner KH, Schutz W, Schirmer U, Beyer M, Georgieff M. Influence of phenylephrine bolus administration on left ventricular filling dynamics in patients with coronary artery disease and patients with valvular aortic stenosis. Anesthesiology. 1994;81(1):49-58.</ref>
			***Increase in afterload and diastolic blood pressure increases perfusion of coronary arteries
			***Reflex bradycardia may also be beneficial
			**[[Norepinephrine]] is a reasonable choice
			**Avoid [[epinephrine]] as beta-1 agonism may increase tachycardia and myocardial perfusion demand
	*In critical cases, particularly in those unstable to undergo emergent surgery, balloon aortic valvuloplasty may be an option as bridge to AVR or palliative care in nonsurgical candidates		*In critical cases, particularly in those unstable to undergo emergent surgery, balloon aortic valvuloplasty may be an option as bridge to AVR or palliative care in nonsurgical candidates

2021-03-14T21:39:19Z

← Revisión anterior		Revisión del 21:39 14 mar 2021
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	*[[Cardiogenic shock]]		*[[Cardiogenic shock]]
	*See [https://www.youtube.com/watch?v=HztsPbymUhA Intro to Aortic Stenosis by Joseph Minardi on YouTube]		*See [https://www.youtube.com/watch?v=HztsPbymUhA Intro to Aortic Stenosis by Joseph Minardi on YouTube]

			==External Links==
			*[[https://www.emra.org/emresident/article/the-crashing-patient-with-critical-aortic-stenosis/ EMRA: The Crashing Patient with Critical Aortic Stenosis]

	==References==		==References==