Aortic stenosis medical therapy
Aortic stenosis Microchapters
Aortic stenosis medical therapy On the Web
American Roentgen Ray Society Images of Aortic stenosis medical therapy
While medical therapy may improve the symptoms of patients with aortic stenosis, medical therapy does not prolong life expectancy. Aortic valve replacement remains the definitive treatment of symptomatic aortic stenosis and it improves both the symptoms and life expectancy of patients with aortic stenosis. When pharmacological therapies are used, extreme caution must be taken in the administration of vasodilators as excess vasodilation may lead to hypotension, a reduction in perfusion pressure to the heart, a further decline in cardiac output and further hypotension. This downward spiral can be fatal and must be avoided at all costs.
More rapid progression of aortic stenosis has been associated with traditional risk factors for atherosclerosis. Based on the similarities that exist between calcific aortic stenosis and atherosclerosis in terms of their pathological features and risk factors, there has been a substantial interest to modify the progression of calcific aortic stenosis with the administration of cholesterol lowering agents such as statins. A number of small, observational studies have demonstrated an association between low cholesterol levels and decreased progression of aortic stenosis, and even regression of calcific aortic stenosis. Administration of rosuvastatin has been associated with a slowing of aortic stenosis progression in a small study.
Extreme care should be taken to avoid excess vasodilation in the patient with critical aortic stenosis which could precipitate a downward spiral of low forward output, impaired subendocardial perfusion, ischemia and further reduction in forward output.
If the patient has symptoms of heart failure, the patient should be placed on sodium restriction.
ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease (DO NOT EDIT)
|"1. It is reasonable to treat systemic hypertension in patients with AS while monitoring diastolic blood pressure to avoid reducing coronary perfusion. (Level of Evidence: C)"|
|"2. It is reasonable to administer beta blockers in patients with BAV and aortic root dilatation. (Level of Evidence: C)"|
|"3. It is reasonable to use long-term vasodilator therapy in patients with AR and systemic hypertension while carefully monitoring diastolic blood pressure to avoid reducing coronary perfusion. (Level of Evidence: C)"|
|"1. It may be reasonable to treat patients with BAV and risk factors for atherosclerosis with statins with the aim of ‘‘slowing down degenerative changes in the aortic valve and preventing atherosclerosis. (Level of Evidence: C)"|
- ↑ Moura LM, Ramos SF, Zamorano JL, et al (2007). "Rosuvastatin affecting aortic valve endothelium to slow the progression of aortic stenosis". J. Am. Coll. Cardiol. 49 (5): 554-61. doi:10.1016/j.jacc.2006.07.072. PMID 17276178.
- ↑ Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, Ettinger SM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Page RL, Riegel B, Tarkington LG, Yancy CW (December 2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Journal of the American College of Cardiology 52 (23): e143–263. doi:10.1016/j.jacc.2008.10.001. PMID 19038677. Retrieved on 2013-01-09.
There is no pharmaceutical or device industry support for this site and we need your viewer supported Donations | Editorial Board | Governance | Licensing | Disclaimers | Avoid Plagiarism | Policies