A 57-year-old man is sent to you for evaluation of a new murmur. He is asymptomatic. His physical examination is unremarkable except for a 1/6 SEM without radiation. An echocardiogram is performed prior to your visit. It reveals a preserved LV EF, no LVH and a tricuspid aortic valve with a 20 mmHg gradient across the aortic valve. What is the next step?
a. TMET evaluation to attempt to elicit symptoms
b. AVR
c. TTE in 3 yrs
d. Catheterization of the right and left sides of the heart
e. Annual echocardiogram
Answer c:
The patient has mild AS by physical examination and echocardiogram. The valve is not bicuspid and his LV and EF is preserved. Therefore, no further assessment and no intervention is necessary. However, according to the ACC/AHA guidelines a followup echocardiogram is indicated at 3 to 5 yrs for mild AS, 1 to 2 yrs for moderate AS, and annually for severe asymptomatic AS.
a. TMET evaluation to attempt to elicit symptoms
b. AVR
c. TTE in 3 yrs
d. Catheterization of the right and left sides of the heart
e. Annual echocardiogram
Answer c:
The patient has mild AS by physical examination and echocardiogram. The valve is not bicuspid and his LV and EF is preserved. Therefore, no further assessment and no intervention is necessary. However, according to the ACC/AHA guidelines a followup echocardiogram is indicated at 3 to 5 yrs for mild AS, 1 to 2 yrs for moderate AS, and annually for severe asymptomatic AS.
