Dr. Usman's Cardiology Notes

  Current guidelines admit, however, that the management of patients with asymptomatic AS (including a normal exercise test) and normal left ventricular function remains controversial. Decision-making requires careful weighing of risk and benefit. In this regard, the fact that catheter interventional treatment of AS is rapidly evolving and recent data demonstrate that the risk of both, surgical AVR and transcatheter aortic valve implantation (TAVI) have markedly decreased over the years has an obvious impact as this may change the threshold to intervene in asymptomatic patients when weighing risk vs. potential benefit. On the other hand, the complexity of long-term planning considering the consequences for later re-interventions, access to coronary arteries after TAVI, and other aspects have been recognized. New important data including randomized controlled trials comparing watchful waiting vs. early surgery in asymptomatic AS have also been provided. Thus, it appears timely to re...

A 78 year old female, diabetic, overweight and hypertensive presented with severe shortness of breath, orthopnea and paroxysmal nocturnal dyspnea. She has limited mobility at home due to easy fatigue. On examination she was restless , tachycardiac with heart rate of 130 beats per minute, respiratory rate of 26 per minute and Blood Pressure of 110/60 mmHg. Auscultation revealed ejection systolic murmur at upper sternal border radiating to neck, S 3 gallop and a displaced PMI on palpation. There were bilateral crackles in the chest. ECG showed ST depression in anterior precordial leads. Labs revealed a Troponin of 170, Creatinine of 2.0 mg/dl and BNP of 1617. Chest X-Ray revealed pulmonary edema. Echocardiography revealed EF of 35%, global hypokinesia, Aortic Valve Area of 0.8cm 2 and a mean gradient of 28 mmHg. a) What are the treatment options available and which would you recommend for her? b) Name recent trial conducted for such intermediate to high risk patients and its result inter...

A 40 years old female presented with chest pain and light headedness on exertion. Examination showed B.P of 110/90 mmHg, delayed carotid upstroke, double apical impulse, Ejection Systolic Murmur radiating to carotid. ECG is remarkable for Left Ventricular Hypertrophy. Echocardiography revealed critical aortic stenosis with Aortic Valve Area of < 1cm 2 , Mean Gradient of 30 mmHg and Left Ventricular Ejection Fraction of 60 %.   a) How would you differentiate between valvular and sub-valvular aortic stenosis? b) What are the indications for cardiac catheterization and how will you calculate Aortic Valve Area? c) What is paradoxical low flow severe Aortic Stenosis and give two reasons for it? d) What are the class I indications of Aortic Valve Replacement? e) What is the most likely reason for severe Aortic Stenosis in this woman? Answers: a.       Clinical findings of valvular aortic stenosis are presence of ejection click and soft A2. In subvalvular AS ...