Recognition and management of aortic stenosis in the elderly.
Angina pectoris, syncope or near-syncope, and congestive heart failure (CHF) are the 3 cardinal manifestations of aortic stenosis (AS) in the elderly. Prolonged duration and late peaking of the aortic systolic ejection murmur best differentiate severe from mild AS. The agreement in quantitation of AS severity between Doppler echocardiography and cardiac catheterization is approximately 95%. The average survival is 3 years after the onset of angina pectoris or syncope and 1.5 to 2 years after the onset of CHF in patients with severe AS who does not undergo surgery. Indications for aortic valve replacement (AVR), for use of warfarin after AVR in patients with mechanical prostheses, and for use of aspirin or warfarin after AVR in patients with bioprostheses are listed in the article.
Aronow
Wilbert S
WS
Department of Medicine, Division of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY, USA.
D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization; D002316:Cardiotonic Agents / Q000627:therapeutic use; D015150:Echocardiography, Doppler; D005260:Female; D015577:Geriatric Assessment; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013575:Syncope / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D014665:Vasodilator Agents / Q000627:therapeutic use
D002316:Cardiotonic Agents; D014665:Vasodilator Agents