Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of progressive exertional dyspnea (NYHA class [I-IV]), exertional syncope, and angina pectoris. Symptoms are consistent with severe aortic stenosis. Denies orthopnea, PND, or palpitations. No recent history of fever or infectious symptoms.
Clinical Examination Findings
Cardiovascular exam reveals a harsh, crescendo-decrescendo systolic ejection murmur (grade [III-VI]/VI) heard best at the right upper sternal border, radiating to the carotid arteries. Pulsus parvus et tardus noted. S2 is soft or absent. No murmurs of aortic regurgitation or mitral pathology. Peripheral pulses are symmetric.
Treatment Protocol
Plan: 1. Referral for urgent transthoracic echocardiogram (TTE) to confirm severity (AVA < 1.0 cm², mean gradient > 40 mmHg, peak velocity > 4 m/s). 2. Cardiology/Cardiothoracic surgery consultation for evaluation of SAVR vs. TAVR. 3. Avoid strenuous physical activity. 4. Optimize blood pressure and manage comorbidities.