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Case of Aortic Stenosis


A 83-year-old  female is admitted to the hospital with gallstone pancreatitis. She is evaluated by General Surgery in the ER and they recommend initial conservative management. On hospital day 3, amylase and lipase are trending down, pain has subsided and she is able to tolerate diet. The surgeon recommends laparoscopic cholecystectomy and asks the hospitalist team for preoperative evaluation.

Past medical history (PMH):
Aortic stenosis, hypertension (HTN).

Atenolol, lisinopril, amlodipine.

What things should be considered in the preoperative evaluation of a patient with aortic stenosis?

 What is the cardiovascular risk for this patient with aortic stenosis?

Final diagnosis?

1. The 2nd question is the answer of the 1st one"cardiovascular risk".
2. almost half of pts with AS also have Coronary artery disease, particularly if > 50 yrs of age.
3. AS and presurgey evaluation to decrease the risk of complications during and post-op.
 A good PMH and current meds are important component to make sure that the pt is  hemodynamically  stable( in this case, pt is not on anti-coag), and consider hypotenion and ischemia. Hypotension is the main thing to worry as pt is on lisinopril and beta blockers,  which has side effect as hypotension. Need to chec the ejection fraction.

thanks doctor absolutely you are right :
1-          Cardiovascular risk
             Endocarditis prophylaxis.

2- the same answer as above.
3- final diagnosis:     Aortic Stenosis and Preoperative Evaluation for Noncardiac Surgery.


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