Management of AS

Many patients will have known longstanding AS and be followed up regularly in outpatients but may present acutely with symptoms as a consequence of decompensation requiring treatment and admission.

Management of acute problems:

Pulmonary oedema

Pulmonary oedema can be treated with diuretics and continuous positive airways pressure (CPAP) to reduce preload and improve ventilatory function.
Nitrates and ACE inhibitors may cause a drop in after load and a significant drop in blood pressure and should be avoided.
Recent excessive diuretics, vasodilator therapy or hypovolaemia may be responsible for the acute decompensation and require corrective measures.

Atrial fibrillation

New-onset AF can be treated with digoxin to slow ventricular response and improve stroke volume.

Chest pain

Chest pain may be relieved by beta blockers, which reduce myocardial oxygen demand and may improve coronary blood flow.

Cardiogenic shock

Up to 6% of older patients present in cardiogenic shock [5]. These patients need aggressive medical therapy and emergency surgery.

Learning bite

Any patient presenting with breathlessness, angina or syncope and found to have a systolic murmur will require careful workup and referral.

Other management issues are that all patients with AS need antibiotic cover for certain surgical procedures to protect against infective endocarditis.