Aortic valve stenosis: Difference between revisions
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In [[medicine]], '''aortic valve stenosis''' is an abnormality of the [[aortic valve]] in the [[heart]].<ref name="pmid11870246">Carabello BA. [http://content.nejm.org/cgi/content/full/346/9/677 Clinical practice. Aortic stenosis]. N Engl J Med. 2002 Feb 28;346(9):677-82. Review. No abstract available. PMID 11870246</ref> | In [[medicine]], '''aortic valve stenosis''' is an abnormality of the [[aortic valve]] in the [[heart]].<ref name="pmid11870246">Carabello BA. [http://content.nejm.org/cgi/content/full/346/9/677 Clinical practice. Aortic stenosis]. N Engl J Med. 2002 Feb 28;346(9):677-82. Review. No abstract available. PMID 11870246</ref> | ||
==Diagnosis== | |||
A [[clinical prediction rule]] may help detecting moderate to severe aortic valve stenosis (defined as a valve area of 1.2 cm<sup>2</sup>or less, or a peak instantaneous gradient of 25 mm Hg or greater):<ref name="pmid9798818">{{cite journal |author=Etchells E, Glenns V, Shadowitz S, Bell C, Siu S |title=A bedside clinical prediction rule for detecting moderate or severe aortic stenosis |journal=Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine |volume=13 |issue=10 |pages=699–704 |year=1998 |month=October |pmid=9798818 |pmc=1500900 |doi= |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0884-8734&date=1998&volume=13&issue=10&spage=699 |issn=}} [http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=citizendium&pubmedid=9798818 PubMed Central]</ref> | |||
* If the murmur does not radiate to the right neck, moderate aortic stenosis was very unlikely | |||
* If the murmur has at least three of the following signs, moderate stenosis was likely: | |||
** slow carotid artery upstroke (other studies suggest more than 200 msec is abnormal<ref name="pmid7236464">{{cite journal |author=Flohr KH, Weir EK, Chesler E |title=Diagnosis of aortic stenosis in older age groups using external carotid pulse recording and phonocardiography |journal=British heart journal |volume=45 |issue=5 |pages=577–82 |year=1981 |month=May |pmid=7236464 |pmc=482567 |doi= |url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=7236464 |issn=}}</ref>) | |||
** reduced carotid artery volume | |||
** murmur loudest at the second right intercostal space | |||
** reduced intensity of the second heart sound | |||
==Treatment== | ==Treatment== | ||
Revision as of 23:07, 6 November 2008
In medicine, aortic valve stenosis is an abnormality of the aortic valve in the heart.[1]
Diagnosis
A clinical prediction rule may help detecting moderate to severe aortic valve stenosis (defined as a valve area of 1.2 cm2or less, or a peak instantaneous gradient of 25 mm Hg or greater):[2]
- If the murmur does not radiate to the right neck, moderate aortic stenosis was very unlikely
- If the murmur has at least three of the following signs, moderate stenosis was likely:
- slow carotid artery upstroke (other studies suggest more than 200 msec is abnormal[3])
- reduced carotid artery volume
- murmur loudest at the second right intercostal space
- reduced intensity of the second heart sound
Treatment
Joint clinical practice guidelines by the American College of Cardiology and the American Heart Association address treatment. [4]
Surgery
Prognosis
Risks factors have been studied.[5]
References
- ↑ Carabello BA. Clinical practice. Aortic stenosis. N Engl J Med. 2002 Feb 28;346(9):677-82. Review. No abstract available. PMID 11870246
- ↑ Etchells E, Glenns V, Shadowitz S, Bell C, Siu S (October 1998). "A bedside clinical prediction rule for detecting moderate or severe aortic stenosis". Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine 13 (10): 699–704. PMID 9798818. PMC 1500900. [e] PubMed Central
- ↑ Flohr KH, Weir EK, Chesler E (May 1981). "Diagnosis of aortic stenosis in older age groups using external carotid pulse recording and phonocardiography". British heart journal 45 (5): 577–82. PMID 7236464. PMC 482567. [e]
- ↑ Bonow RO, Carabello BA, Kanu C, de Leon AC Jr, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Page RL, Riegel B.ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons.Circulation. 2006 Aug 1;114(5):e84-231. PMID 16880336 (see page 462 for indications for replacement)
- ↑ Rosenhek R, Binder T, Porenta G, Lang I, Christ G, Schemper M, Maurer G, Baumgartner H.Predictors of outcome in severe, asymptomatic aortic stenosis.N Engl J Med. 2000 Aug 31;343(9):611-7. PMID 10965007