Aortic stenosis prevention: Difference between revisions

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| [[File:Siren.gif|30px|link=Aortic stenosis resident survival guide]]|| <br> || <br>
| [[Aortic stenosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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{{Aortic stenosis}}
{{Aortic stenosis}}
{{CMG}}; '''Associate Editor-In-Chief:''' [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]
{{CMG}}; '''Associate Editor-In-Chief:''' [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]; {{USAMA}}


==Overview==
==Overview==
Aortic stenosis associated with rheumatic heart disease can be minimized with antibiotic therapy in patients with documented [[streptococcal pharyngitis]] ([[strep throat]]). [[Bicuspid aortic valve disease]] is a congenital variant and cannot be prevented. Calcific degeneration of the valve can potentially be minimized by rosouvistatin and other measures targeting atherosclerosis prevention.
The risk of developing aortic stenosis following [[rheumatic heart disease]] can be minimized with early [[antibiotic]] therapy among patients with documented [[streptococcal pharyngitis]] ([[strep throat]]).<ref name="pmid7567345">{{cite journal| author=Dajani A, Taubert K, Ferrieri P, Peter G, Shulman S| title=Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals. Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, the American Heart Association. | journal=Pediatrics | year= 1995 | volume= 96 | issue= 4 Pt 1 | pages= 758-64 | pmid=7567345 | doi= | pmc= | url= }} </ref> [[Bicuspid aortic valve]] disease is a congenital variant and cannot be prevented. As for calcific aortic stenosis, a number of small, [[observational studies]] have demonstrated an association between lowering cholesterol levels and decreasing the progression of the aortic stenosis;<ref>{{cite journal |author=Moura LM, Ramos SF, Zamorano JL, ''et al'' |title=Rosuvastatin affecting aortic valve endothelium to slow the progression of aortic stenosis |journal=J. Am. Coll. Cardiol. |volume=49 |issue=5 |pages=554-61 |year=2007 |pmid=17276178 |doi=10.1016/j.jacc.2006.07.072}}</ref> however, randomized clinical trials have failed to corroborate these findings.<ref name="pmid18765433">{{cite journal| author=Rossebø AB, Pedersen TR, Boman K, Brudi P, Chambers JB, Egstrup K et al.| title=Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. | journal=N Engl J Med | year= 2008 | volume= 359 | issue= 13 | pages= 1343-56 | pmid=18765433 | doi=10.1056/NEJMoa0804602 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18765433  }} </ref><ref name="pmid15944423">{{cite journal| author=Cowell SJ, Newby DE, Prescott RJ, Bloomfield P, Reid J, Northridge DB et al.| title=A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 23 | pages= 2389-97 | pmid=15944423 | doi=10.1056/NEJMoa043876 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15944423  }} </ref><ref name="pmid20048204">{{cite journal| author=Chan KL, Teo K, Dumesnil JG, Ni A, Tam J, ASTRONOMER Investigators| title=Effect of Lipid lowering with rosuvastatin on progression of aortic stenosis: results of the aortic stenosis progression observation: measuring effects of rosuvastatin (ASTRONOMER) trial. | journal=Circulation | year= 2010 | volume= 121 | issue= 2 | pages= 306-14 | pmid=20048204 | doi=10.1161/CIRCULATIONAHA.109.900027 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20048204  }} </ref>
 
==Prevention==
Early antibiotic treatment of [[streptococcal pharyngitis]] prevents [[rheumatic fever]] and the development of aortic stenosis later in life <ref name="pmid7567345">{{cite journal| author=Dajani A, Taubert K, Ferrieri P, Peter G, Shulman S| title=Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals. Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, the American Heart Association. | journal=Pediatrics | year= 1995 | volume= 96 | issue= 4 Pt 1 | pages= 758-64 | pmid=7567345 | doi= | pmc= | url= }} </ref>. The incidence of [[rheumatic fever]] decreased before introduction of antibiotics, suggesting that other factors are involved as well <ref name="pmid7567345">{{cite journal| author=Dajani A, Taubert K, Ferrieri P, Peter G, Shulman S| title=Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals. Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, the American Heart Association. | journal=Pediatrics | year= 1995 | volume= 96 | issue= 4 Pt 1 | pages= 758-64 | pmid=7567345 | doi= | pmc= | url= }} </ref>.


==References==
==References==
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Latest revision as of 16:12, 5 January 2017



Resident
Survival
Guide

Aortic Stenosis Microchapters

Home

Patient Information

Overview

Historical Perspective

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Pathophysiology

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Differentiating Aortic Stenosis from other Diseases

Epidemiology and Demographics

Risk Factors

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Diagnosis

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Aortic Valve Area

Aortic Valve Area Calculation

Treatment

General Approach

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Surgery

Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty

Transcatheter Aortic Valve Replacement (TAVR)

TAVR vs SAVR
Critical Pathway
Patient Selection
Imaging
Evaluation
Valve Types
TAVR Procedure
Post TAVR management
AHA/ACC Guideline Recommendations

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Prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Mohammed A. Sbeih, M.D. [2]; Usama Talib, BSc, MD [3]

Overview

The risk of developing aortic stenosis following rheumatic heart disease can be minimized with early antibiotic therapy among patients with documented streptococcal pharyngitis (strep throat).[1] Bicuspid aortic valve disease is a congenital variant and cannot be prevented. As for calcific aortic stenosis, a number of small, observational studies have demonstrated an association between lowering cholesterol levels and decreasing the progression of the aortic stenosis;[2] however, randomized clinical trials have failed to corroborate these findings.[3][4][5]

References

  1. Dajani A, Taubert K, Ferrieri P, Peter G, Shulman S (1995). "Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals. Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, the American Heart Association". Pediatrics. 96 (4 Pt 1): 758–64. PMID 7567345.
  2. 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.
  3. Rossebø AB, Pedersen TR, Boman K, Brudi P, Chambers JB, Egstrup K; et al. (2008). "Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis". N Engl J Med. 359 (13): 1343–56. doi:10.1056/NEJMoa0804602. PMID 18765433.
  4. Cowell SJ, Newby DE, Prescott RJ, Bloomfield P, Reid J, Northridge DB; et al. (2005). "A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis". N Engl J Med. 352 (23): 2389–97. doi:10.1056/NEJMoa043876. PMID 15944423.
  5. Chan KL, Teo K, Dumesnil JG, Ni A, Tam J, ASTRONOMER Investigators (2010). "Effect of Lipid lowering with rosuvastatin on progression of aortic stenosis: results of the aortic stenosis progression observation: measuring effects of rosuvastatin (ASTRONOMER) trial". Circulation. 121 (2): 306–14. doi:10.1161/CIRCULATIONAHA.109.900027. PMID 20048204.


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