11 Feb Aortic Stenosis

Why internists love this topic so much is beyond me.  There is essentially no medical management that improves the condition.  We just have to sit around long enough for the patient to get sick enough to refer to a surgeon.  When are they sick enough?  This slide from the AHA Valvular Heart Disease guidelines is a nice flowchart.  Essentially any patient with severe AS with symptoms or LV systolic dysfunction (EF<50) should be referred for valve surgery.

Also remember the association of colonic arterivenous malformations and AS, also known as Heyde Syndrome.  In the case presented today, symptomatic gastrointestinal hemorrhage complicated management and necessitated placement of a tissue rather than mechanical valve so as to avoid anticoagulation.