Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea (NYHA class [I-IV]), orthopnea, and paroxysmal nocturnal dyspnea. Reports symptoms of reduced cardiac output including palpitations, lightheadedness, or exertional syncope. Denies chest pain or anginal equivalents. History significant for [bicuspid aortic valve/rheumatic heart disease/connective tissue disorder/endocarditis].
Clinical Examination Findings
Cardiovascular exam reveals a hyperdynamic precordium with a displaced apical impulse. Auscultation demonstrates a high-pitched, blowing, decrescendo diastolic murmur heard best at the left sternal border (Erb’s point). Presence of a wide pulse pressure, Corrigan’s pulse (water-hammer pulse), and de Musset’s sign. No signs of peripheral edema or jugular venous distension unless in decompensated heart failure.
Treatment Protocol
Management plan includes strict blood pressure control (target SBP <130 mmHg) using vasodilators (ACE inhibitors, ARBs, or CCBs). Referral for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) indicated for symptomatic patients or asymptomatic patients with LVEF ≤50% or LVESD >50mm. Serial echocardiographic monitoring every 6-12 months.