Summary:

This patient's echocardiogram demonstrated moderate LVH and calcific aortic stenosis with a mean gradient of 40 mm Hg (moderately severe).

Click to review auscultation.

Lessons:

1. This patient's coronary arteries were normal on cardiac catheterization. His angina was due entirely to his aortic stenosis.
2. The carotid bruits, the slow carotid upstrokes, and the abnormal apex impulse, all pointed to significant aortic valve stenosis even before auscultation of the heart and echocardiography.
3. Because he now has a bioprosthesis in the aortic position, he requires antibiotic prophylaxis against infective endocarditis, but he does not require anticoagulant therapy. He has also been transferred to a desk job in the police department.

 

Case 9 is now finished.