A 50 year old man with aoic stenosis is doing exercise for 11 minutes according to bruce protocol. Exercise stopped due to fatigue, Regional pressure gradient is 60 mm Hg between the two sides of the aoic valve. What is the best management -
Aoic stenosis (AS or AoS) is the narrowing of the exit of the left ventricle of the hea (where the aoa begins), such that problems result.It may occur at the aoic valve as well as above and below this level. It typically gets worse over time. Symptoms often come on gradually with a decreased ability to exercise often occurring first. If hea failure, loss of consciousness, or hea related chest pain occur due to AS the outcomes are worse. Loss of consciousness typically occurs with standing or exercise. Signs of hea failure include shoness of breath especially when lying down, at night, or with exercise, and swelling of the legs.Thickening of the valve without narrowing is known as aoic sclerosis Treatment is generally not necessary in people without symptoms. In moderate cases echocardiography is performed every 1-2 years to monitor the progression, possibly complemented with a cardiac stress test.In severe cases, echocardiography is performed every 3-6 months.In both moderate and mild cases, the person should immediately make a revisit or be admitted for inpatient care if any new related symptoms appear.There are no therapeutic options currently available to treat people with aoic valve stenosis; however, studies have indicated that the disease occurs as a result of active cellular processes, suggesting that targeting these processes may lead to ble therapeutic approaches Ref Davidson 23rd edition pg 453
Angiogram
Aoic valve replacement
Aoic ballooning to prevent fuher derangement
Observation
C.V.S