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Chest Pain 

Chest Pain
Chest Pain
Acute Care Casebook

Andrew Caddell


This case addresses symptomatic severe aortic stenosis (AS). AS symptoms typically are chest pain, dyspnea, and syncope. Physical exam findings of AS may be present regardless of severity of aortic stenosis, and they include slow rate of rise of the carotid pulse, mid- to late peak intensity of the murmur, and decreased intensity of the second heart sound. Medical management of symptomatic aortic stenosis is challenging. In the presence of the fixed outlet obstruction of AS, vasodilators (such as nitroglycerin) must be used with caution. The definitive management of aortic stenosis is surgical. Among frail patients, transcatheter aortic valve implantation is a reasonable alternative to open surgery.

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