RT Book, Section A1 Kiefer, Todd A1 Granger, Christopher B. A1 Jackson, Kevin P. A2 Papadakis, Maxine A. A2 McPhee, Stephen J. A2 Rabow, Michael W. A2 McQuaid, Kenneth R. SR Print(0) ID 1193147096 T1 Aortic Stenosis T2 Current Medical Diagnosis & Treatment 2023 YR 2023 FD 2023 PB McGraw-Hill Education PP New York, NY SN 9781264687343 LK accessmedicine.mhmedical.com/content.aspx?aid=1193147096 RD 2024/10/05 AB ESSENTIALS OF DIAGNOSISCongenital bicuspid aortic valve (usually asymptomatic until middle or old age).“Degenerative” or calcific aortic stenosis; similar risk factors as atherosclerosis (symptoms usually in the elderly).Visual observation of immobile aortic valve plus a valve area of less than 1.0 cm2 define severe disease; low-gradient but severe aortic stenosis can thus be recognized when the stroke volume is reduced.Delayed and diminished carotid pulses.Soft, absent, or paradoxically split S2.Harsh systolic murmur, sometimes with thrill along left sternal border, often radiating to the neck; may be louder at apex in older patients.ECG usually shows LVH; calcified valve on radiography or fluoroscopy.Echocardiography/Doppler is diagnostic.Surgery typically indicated for symptoms. TAVR is approved for patients with calcific aortic stenosis.Intervention appropriate even in asymptomatic patients with super-severe aortic stenosis (mean gradient greater than 55 mm Hg) or when undergoing heart surgery for other reasons (eg, coronary artery bypass grafting [CABG]).BNP is a marker of early LV myocardial failure, and high levels (three times normal) suggest poor prognosis and can be an indication for intervention.