A person with aoic stenosis could perform exercise for 11 minutes in Bruce protocol. Exercise had to be stopped due to fatigue. He had a peak systolic gradient of 60 mm Hg across the aoic valve at rest. The best management for him would be?
Medical management
Aoic valve balloon dilation to prevent worsening
Aoic valve replacement
Coronary angiography
Diagnosis: Severe AS as trans-valvular peak gradient of 60 mmHg. Since patient managed to perform on the Treadmill for up to stage 3 (beyond 9 minutes) of Bruce protocol without any ECG changes - ASYMPTOMATIC SEVERE AOIC STENOSIS. In Modified Bruce protocol there are 7 stages of 3 minutes each on a treadmill, for which the patient walks on the treadmill at a gradually increasing speed.. There is a change in guidelines with surgery being indicated for asymptomatic severe AS due to progressive nature of disease. Indications for Aoic valve replacement: An abnormal response to treadmill exercise. Rapid progression of AS, especially when urgent access to medical care might be compromised Very severe AS defined by a valve area <0.6 cm2. Severe LVH suggested by a wall thickness of >15 mm.
Valvular hea diseases