(精选)【高血压精品英文课件】Valvular Stenosis教学课件.pptVIP

Question Which one of the following is appropriate next? ?A. Treat him symptomatically for viral infection, discuss antibiotic prophylaxis, and arrange follow-up visit. ?B. Refer for aortic valve replacement as soon as possible. ?C. Treat with penicillin and aspirin and start rheumatic fever prophylaxis. ?D. Eliminate balloon valvotomy as a therapeutic option due to age and presence of aortic regurgitation. ?E. Draw blood cultures and initiate IV antibiotics for treatment of endocarditis. Answer The correct answer is A. Because the patient has viral pleurisy and an exam consistent with moderate aortic stenosis, likely congenital, prophylaxis and regular follow up are important. Referring for aortic valve replacement is inappropriate because aortic stenosis is moderate and asymptomatic, so follow-up is appropriate. You could consider a valvotomy, as gradient is 50mm and he has LVH, but not valve replacement. There are insufficient criteria for rheumatic fever and the echo findings are classic for congenital AS. Although he could have a valvotomy, he has a mobile, bicuspid valve with mild and inaudible aortic regurgitation and no contraindications. Making a distinction between whether he is an adolescent, reaching pediatric criteria for intervention, or an adult is of no consequence in this instance. Blood cultures and IV antibiotics are not called for because viral syndrome is likely. He should instead be instructed to monitor fever, report if high and chills, and be given no antibiotics. Blood cultures could be drawn, but likely will be negative. Question A 77-year-old man with chronic angina pectoris of 3 years duration has had increasing symptoms for the past 6 weeks with episodes at rest, nocturnal episodes, and prolonged episodes with effort often requiring two to three sublingual nitroglycerins (instead of the usual one or rest) for relief. His overall health is good. He is known to have aortic stenosis of moderate degree with typical findings. His