What's the Take Home?
A 79-Year-Old Man With Aortic Stenosis
Ronald N. Rubin, MD1,2—Series Editor
1Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
2Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania
Rubin RN. A 79-year-old man with aortic stenosis. Consultant. 2021;61(5):e17-e19. doi:10.25270/con.2021.05.00003
The author reports no relevant financial relationships.
Ronald N. Rubin, MD, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA 19140 (email@example.com)
A 79-year-old man is being evaluated for aortic stenosis. He is known to have had aortic stenosis for the last several years, with serial clinical follow-up visits for symptoms and noninvasive tests for aortic stenosis parameters.
One year ago, his transaortic valve gradient was 44 mm Hg and jet velocity was 3.5 cm/sec. He is a lifelong heavy smoker, and results of a positron emission tomography (PET) scan showed limited lung function and capacity such that surgical aortic valve replacement (SAVR) was deemed too risky at that time. He denies angina and congestive heart failure (CHF) symptoms, but his chronic obstructive pulmonary disease (COPD) renders an accurate evaluation of this difficult, since his ambulation capacity and universe are limited. His cardiac ejection fraction has been in the range of 50% to 59%.
A battery of test results now shows progression of his aortic stenosis such that the gradient is now 55 mm Hg with an aortic valve area of 0.9 cm2 and jet velocity of 4.0 cm/sec. His ejection fraction remains at 50%. However, a chest radiograph revealed a new speculated mass of 4 cm in diameter in the right lung proximally with bilateral mediastinal adenopathy. PET scan findings have been markedly consistent with a diagnosis of bronchogenic carcinoma of the mass and mediastinal lymph nodes.
Physical examination findings reveal a thin man who is comfortable at rest. His blood pressure is 105/75 mm Hg, pulse is 96 bpm, and respiration is 16 br/min. A significant delay of the carotid pulsation into the neck is noted. His chest has diminished breath sounds, but bilateral fine wheezes are present. His cardiac rhythm is regular, and a coarse, rasping systolic murmur is heard over the precordium. Trace pedal edema is present.
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