Interesting Step-3CCS Exam Case
vishalsheth - 09-03-10 09:22

You are seeing an 86-year-old male patient with severe
aortic stenosis in follow-up. He has had severe aortic stenosis
for 4 years without symptoms. Recently, he has
scaled back his activities due to light-headedness with exertion.
His wife reports one episode a week ago when he
passed out briefly while trying to do his gardening. On
examination, his blood pressure is 150/85 mmHg, heart
rate is 76 beats/min. He has a grade III/VI systolic ejection
murmur that extends to S2 with radiation to the carotids.
S2 is barely audible, consistent with his prior
examinations. Carotid pulses are delayed as they have
been in the past. He has femoral and abdominal aortic
bruits. Peripheral pulses are 2+ bilaterally. Laboratory
data show a creatinine of 0.9 mg/dL, low-density lipoprotein
cholesterol of 75 mg/dL, high-density lipoprotein of
50 mg/dL. What is the next appropriate step in this patient’s
management?