Aortic stenosis medical therapy

Aortic Stenosis Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Claudia P. Hochberg, M.D. [2]; Abdul-Rahman Arabi, M.D. [3]; Keri Shafer, M.D. [4]; Priyamvada Singh, MBBS [5]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [6]

Overview

Prior to surgical intervention, clinicians may opt to utilize medical therapy for aortic stenosis treatment. Pharmacological therapies can be used on some aortic stenosis patients. Caution must be taken in avoiding complications such as excess vasodilation, as it could lead to functional decline in the patient. Medical treatment is primarily symptomatic. The patient should be treated medically if there are no indications for aortic valve replacement or aortic balloon valvotomy.

Medical Therapy

Pharmacotherapy

Aortic stenosis may be medically treated to control symptoms. 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 reductions in forward output. Medications that may be used to control the symptoms of aortic stenosis includes:

• Beta blockers and angiotensin-converting enzyme inhibitors, are generally safe for asymptomatic patients with preserved left ventricular systolic function.
• Nitroglycerin is helpful in relieving angina pectoris symptoms but should be used cautiously to avoid hypotention.
• Some studies showed that patients with calcific AS who receive HMG-CoA reductase inhibitors (statins) exhibit slower progression of leaflet calcification and aortic valve area reduction than those who do not.

Patients with severe AS (< 1.0 cm2) should avoid strenuous physical activity. If the patient has symptoms of heart failure, the symptoms should be controlled and he should have sodium restriction. The phisicion may administer diuretics and digoxin catiousely to avoid dehydration, hypovolemia and significant reduction in cardiac output.