Summary:
This patient's echocardiogram demonstrated moderate LVH and calcific aortic stenosis with a mean gradient of 40 mm Hg (moderately severe).
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to review auscultation.
Lessons:
- This patient's coronary arteries were normal on cardiac catheterization. His angina was due entirely to his aortic stenosis.
- 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.
- 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.