Aortic stenosis: Hypotension Rx

Aortic stenosis is the most common cardiac valve lesion in the United States. The underlying cause is progressive calcification and sclerosis of the aortic valve leaflets, due either to a congenital condition (Bicuspid Aortic Valve is found in 1-2% of the population), or as a natural part of the ageing process. The classic triad of symptoms is angina, syncope, and congestive heart failure.

In hypotensive patients with aortic stenosis,Phenylephrine is the vasopressor choice. “The rationale is 3-fold: (a) if left ventricular (LV) afterload is relatively fixed by the stenotic valve, increasing peripheral vascular resistance will have less of an effect on myocardial work than it would on an “unloaded” left ventricle; (b) increases in diastolic blood pressure will presumably increase CPP, and thus myocardial DO₂; and (c) reflexive bradycardia reduces myocardial consumption of oxygen (VO₂).”