A person with aoic stenosis could perform exercise for 11 minutes in Bruce protocol. Exercise had to be stopped due to fatigue. He had a peak systolic gradient of 60 mm Hg across the aoic valve at rest. The best management for him would be?
Diagnosis: Severe AS as trans-valvular peak gradient of 60 mmHg. Since patient managed to perform on the Treadmill for up to stage 3 (beyond 9 minutes) of Bruce protocol without any ECG changes - ASYMPTOMATIC SEVERE AOIC STENOSIS. In Modified Bruce protocol there are 7 stages of 3 minutes each on a treadmill, for which the patient walks on the treadmill at a gradually increasing speed.. There is a change in guidelines with surgery being indicated for asymptomatic severe AS due to progressive nature of disease. Indications for Aoic valve replacement: An abnormal response to treadmill exercise. Rapid progression of AS, especially when urgent access to medical care might be compromised Very severe AS defined by a valve area <0.6 cm2. Severe LVH suggested by a wall thickness of >15 mm.
Medical management
Aoic valve balloon dilation to prevent worsening
Aoic valve replacement
Coronary angiography
Valvular hea diseases