Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of known severe aortic stenosis. Reports symptoms of [exertional dyspnea / angina / syncope / near-syncope]. Symptoms are [progressive / stable] over the past [duration]. Functional capacity is limited to [NYHA Class I-IV]. Denies orthopnea, PND, or peripheral edema.
Clinical Examination Findings
Cardiovascular exam reveals a harsh, late-peaking systolic ejection murmur (grade [III-VI]/VI) heard best at the right upper sternal border with radiation to the carotids. Findings include a diminished/delayed carotid upstroke (pulsus parvus et tardus) and a soft or absent S2. Point of maximal impulse is [displaced / sustained]. No evidence of congestive heart failure.
Treatment Protocol
Management plan includes [serial echocardiographic monitoring / surgical aortic valve replacement (SAVR) / transcatheter aortic valve replacement (TAVR)]. Patient advised to avoid strenuous physical exertion. Initiate [beta-blockers / ACE inhibitors] with caution if indicated for comorbid hypertension. Referral to cardiothoracic surgery for definitive intervention.