Question: Does my patient have significant aortic stenosis?
A 72 year-old woman with a history of CHF presents with several weeks of gradually progressive dyspnea on exertion (DOE). At her baseline, she is able to walk several blocks, but now feels winded. She denies chest pain, palpitations, syncope/near syncope, cough, orthopnea, or PND. She states she is compliant with her medications and diet. She has had a recent functional study that showed minimal ischemia.
Meds |
aspirin |
PE |
HR 90, regular |
Labs |
chem 7: |
CV |
RRR, normal S1 and S2 PMI is mildly enlarged and sustained |
Neck |
Carotid pulse is brisk. |
CXR |
Xray shows cardiomegaly and mild vascular redistribution |
ECG |
Unchanged with an incomplete LBBB pattern |
Clinical Diagnosis
Worsening of her congestive heart failure (positive AJR, enlarged and sustained PMI, cardiomegaly, and vascular redistribution).
Clinical Questions
Is this patient’s worsening CHF due to significant aortic stenosis?