Emergency Care for Aortic Stenosis

Aortic stenosis is the obstruction of blood flow across the aortic valve. The aortic valve has three flaps (cusps). Blood flows through the valve when the left ventricle contracts at the early part of the heartbeat. When the left ventricle relaxes, the aortic valve closes. Then the mitral valve opens to allow more blood into the ventricle ready for the next heartbeat.

The main causes of aortic stenosis include:
  • A birth defect of the aortic valve, which normally has three cusps:
  • An aortic valve that has only one cusp or is otherwise stenotic from birth
  • A bicuspid (two-part) aortic valve with progressive wear and tear
  • Progressive calcification of the aortic valve with age (most common in elderly)
  • Rarely, scarring of the aortic valve caused by Rheumatic Fever

The classic triad of symptoms in patients with aortic stenosis is as follows :
  • Chest pain: Angina pectoris in patients with aortic stenosis is typically precipitated by exertion and relieved by rest
  • Heart failure: Symptoms include paroxysmal nocturnal dyspnea, orthopnea, dyspnea on exertion, and shortness of breath
  • Syncope: Often occurs upon exertion when systemic vasodilatation in the presence of a fixed forward stroke volume causes the arterial systolic blood pressure to decline

Emergency Care for Aortic Stenosis

A patient presenting with uncontrolled heart failure should be treated supportively with oxygen, cardiac and oximetry monitoring, intravenous access, loop diuretics, nitrates (remembering the potential nitrate sensitivity of patients with aortic stenosis), morphine (as needed and tolerated), and noninvasive or invasive ventilatory support (as indicated). Patients with severe heart failure due to aortic stenosis that is resistant to medical management should be considered for urgent surgery.

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