Cardiology>>>>>Valvular heart disease and Endocarditis
Question 7#

A 79-year-old retired farmer with known aortic stenosis (AS) returns for his annual surveillance echocardiogram. He remains physically active with no symptoms. His BP is 180/110 mmHg.

The following summary is obtained:

Which one of the following statements is correct?

A. A statin should be prescribed to reduce the rate of AS progression
B. An antihypertensive drug should be prescribed
C. The increase in peak velocity of ≥0.2 m/s/year suggests that surgery should be considered
D. An exercise tolerance test (ETT) is unsafe in asymptomatic severe AS
E. An elevated BNP of 120 pg/ml suggests that surgery should be considered

Correct Answer is B

Comment:

There is no good evidence from randomized controlled trials that statins affect the progression of AS. Exercise testing is contraindicated in symptomatic patients with AS but is recommended in physically active patients for unmasking symptoms and in the risk stratification of asymptomatic patients with severe AS. The development of symptoms or a fall in blood pressure is a predictor of symptom development/poor outcome and therefore is an indication for surgery (ESC Guidelines 2012). In addition, the guidelines recommend that if patients are not physically active or exercise testing is negative, surgery should or may be considered in the presence of specific risk factors and low/intermediate individual surgical risk. Risk factors for consideration of aortic valve surgery are shown in following box:

A BNP level of 120 pg/mL is only mildly elevated and may be due to other causes. A very raised BNP level is defined as >400 pg/mL.