When do I get an echo on my asymptomatic patient with severe aortic stenosis?

When do I get an echo on my asymptomatic patient with severe aortic stenosis? - #44

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This Fast Fact reviews the pathophysiology of severe asymptomatic aortic stenosis and helps determine when to order a Transthoracic Echocardiogram (TTE) for  diagnostic evaluation.

Older individuals with severe asymptomatic aortic stenosis.

Provide screening TTE recommendations in asymptomatic severe aortic stenosis patients.

  1. List the 3 symptoms that are associated with increased short term mortality in patients with severe aortic stenosis.
  2. Identify which asymptomatic patients with aortic stenosis need further diagnostic imaging with a TTE.
  3. Identify patients with aortic stenosis that need more frequent TTE imaging.

1. Fried LP, Borhani NO, Enright P, Furberg CD, Gardin JM, Kronmal RA, et al. The Cardiovascular Health Study: design and rationale. Ann Epidemiol. 1991;1:263–76.

2. Stewart BF, Siscovick D, Lind BK, et al. Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol 1997; 29:630.

3. Khitha J, Bajwa T. Aortic Stenosis, in The Encyclopedia of Elder Care: The Comprehensive Resource on Geriatric Health and Social Care, third edition. Capezuti EA, Malone MI,  Katz PR, Mezey M, editors, Springer Publishing Company. December 2013.

4. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, O’Gara PT, Ruiz CE Skubas NJ, Sorajja P, Sundt TM III, Thomas JD, 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease, Journal of American College of Cardiology(2014) doi: 10.1016/j.jacc.2014.02.536.

5. Carabello BA. Evaluation and management of patients with aortic stenosis. Circulation. 2002;105:1746–50.

6. Carabello BA, Paulus WJ. Aortic stenosis. Lancet. 2009;373:956–66.

7. Roberts WC, Ko JM. Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation. Circulation 2005; 111:920.

8. Cosmi JE, Kort S, Tunick PA, et al. The risk of the development of aortic stenosis in patients with "benign" aortic valve thickening. Arch Intern Med. 2002;162(20):2345.

9. Rosenhek R, Binder T, Porenta G et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med. 2000;343(9):611.

This GFF ___ my competence in geriatrics.

Harpreet Parmar MD, Michael Malone MD, and Jayant Khitha MD

Aurora Health Center, Milwaukee, Wisconsin