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Metoprolol
0%
0/5
Valsartan
Spironolactone
20%
1/5
Furosemide
Surgery
80%
4/5
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The patient presents with signs of heart failure and a systolic murmur consistent with symptomatic aortic stenosis. Surgery is the only management indicated for symptomatic aortic stenosis. Medical therapies are not used to treat symptomatic aortic stenosis. Management of aortic stenosis patients is straightforward: asymptomatic patients receive no treatment, while symptomatic patients receive aortic valve replacement. An aortic valve area of <0.8 cm^2 indicates severe aortic stenosis. A normal aortic valve area is 3 to 4 cm^2. Grimard reviews the diagnosis and treatment of aortic stenosis. He reports that aortic stenosis is present in an estimated 3 percent of the population. During the asymptomatic phase of the disease, left ventricular hypertrophy compensates for the increase in afterload caused by the stenotic valve. When compensation becomes inadequate, symptoms evolve, including angina, syncope, and congestive heart failure. Eveborn studied 164 patients with aortic stenosis and found that prognosis after valvular replacement surgery was comparable to the general population. Illustration A shows a calcified aortic valve in aortic stenosis, as indicated by the arrow. Incorrect Answers: Answers 1-4: Each of these medications are useful in the symptomatic and long-term management of congestive heart failure. None is useful in the treatment of aortic stenosis.
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