1. Aortic Stenosis, the most common valvular heart disease in the Western World, is a narrowing of the aortic valve opening with presentations that can range from assymptomatic to angina (5 year mortality of 50% if AV not replaced), syncopy (3 year mortality at 50% if AV not replaced), or CHF (2 year mortality at 50% if AV not replaced).
|Severity of Aortic Stenosis|
|Degree of aortic stenosis||Mean gradient
|Aortic valve area
|Mild aortic stenosis||<25||>1.5|
|Moderate aortic stenosis||25 – 40||1.0 – 1.5|
|Severe aortic stenosis||>40||< 1.0|
|Critical aortic stenosis||>70||< 0.6|
2. Patients with supravavlular aortic stenosis (SVAS) often present with unequal blood pressures in the upper extremities, which is thought to be explained by the Coanda effect. The Coanda effect is the tendency of a jet stream to adhere to a wall, and in supravalvular AS, the high velocity stream tends to adhere to the right aortic wall, causing disproportionately high pressure in the right arm.
3. Recommendation for treating Community Acquired PNA in a patient admitted to the ICU include givein Ceftriaxone and Azithromycin, with or without Vancomycin (add Vanc if patient has risk factors for MRSA infection including prior influenza, presence of cavitary disease, or empyema.