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Recognition and management of aortic stenosis in the elderly

Wilbert S Aronow1

  • 1Department of Medicine, Division of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY, USA.

Geriatrics
|December 12, 2007
PubMed

Insights

Elderly patients with severe aortic stenosis (AS) face poor survival without surgery. Key symptoms include chest pain, fainting, and heart failure, with murmur characteristics helping diagnose AS severity.

Area of Science:

  • Cardiology
  • Geriatrics
  • Valvular Heart Disease

Background:

  • Aortic stenosis (AS) is a common valvular heart disease in the elderly.
  • Cardinal manifestations include angina pectoris, syncope, and congestive heart failure (CHF).
  • Accurate assessment of AS severity is crucial for clinical management.

Purpose of the Study:

  • To summarize the clinical manifestations, diagnostic methods, and prognostic implications of aortic stenosis in the elderly.
  • To outline indications for aortic valve replacement (AVR) and anticoagulation strategies post-AVR.

Main Methods:

  • Review of clinical findings, including characteristic systolic ejection murmur.
  • Comparison of Doppler echocardiography and cardiac catheterization for AS severity quantitation.
  • Analysis of survival data based on symptoms and surgical intervention.

Main Results:

  • Prolonged duration and late peaking of the aortic systolic ejection murmur indicate severe AS.
  • Doppler echocardiography and cardiac catheterization show high agreement (approx. 95%) in AS severity assessment.
  • Survival is significantly limited in severe AS patients without surgery (2 years for CHF, 3 years for angina/syncope).

Conclusions:

  • Early diagnosis and intervention for severe aortic stenosis in the elderly are critical.
  • Aortic valve replacement (AVR) is indicated for severe symptomatic AS.
  • Specific anticoagulation guidelines exist for mechanical and bioprosthetic valves post-AVR.

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