Management of Asymptomatic Severe Aortic Stenosis (AS) | Patient Case Quiz

Dec 30, 2014   |  Xiushui Ren, MD
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History of Presenting Illness:
A 64-year-old man is referred for systolic murmur and abnormal echocardiogram. He has a history of hypertension. He does not smoke, is physically active (walks briskly for three miles per day), and consumes a healthy diet. He has no symptoms. Medications include aspirin, high-intensity statin (atorvastatin), and angiotensin converting enzyme inhibitor. Blood pressure is 120/80 mmHg and heart rate is 65 beats per minute.

Figure 1

Figure 1

Electrocardiogram (ECG):
Sinus rhythm, normal axis and intervals, no ST-segment abnormalities

Echocardiogram:
Normal biventricular systolic function, ejection fraction 60-65%, with mild concentric LVH
Normal biatrial size
Heavily calcified aortic valve, unable to discern valve morphology; Vmax 5 m/s, peak gradient 99 mmHg, mean gradient 60 mmHg, calculated aortic valve area 0.5 m2. (Figure 1)
Pulmonary artery systolic pressure is 28 mmHg based on an RA pressure of 5 mmHg.

Which of the following is NOT correct?

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