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Medical treatment in aortic stenosis

Patients with asymptomatic aortic stenosis have relatively good immediate prognosis despite the severity of valve stenosis, and conservative management is adequate in them.These  patients should be kept under regular follow up.Development of angina, syncope, symptoms of low cardiac output or heart failure are all associated with  poor prognosis and they indicate the need for surgery.

Take the following precaution
1. Avoid strenuous physical activity and competitive sports in patients with severe valvular stenosis  (valve area <1 cm 2 ).It should be avoided even if the  patient is in asymptomatic stage. 
2. Take special precaution to avoid dehydration and hypovolemia as it may reduce cardiac output.
3. Drugs used for the treatment of hypertension or coronary artery disease, including beta blockers and ACE inhibitors, are safe for asymptomatic patients if they have  preserved left ventricular systolic function.

Drugs for symptom relief in aortic stenosis
1. Nitroglycerin can relieve the angina pectoris in patients with coexistent CAD.
2. Retrospective studies have shown that those patients with degenerative calcific AS if treated with HMG-CoA reductase inhibitors(statins)show slower progression of aortic leaflet calcification and lesser reduction of aortic valve area.However,certain randomized prospective studies with high-dose atorvastatin or combination simvastatin/ ezetimibe donot exihibit favourable valve related outcomes.But statins are useful in reducing CAD risk.

Need for Infective endocarditis prophylaxis
Infective endocarditis prophylaxis is required in AS patients with a previous history of endocarditis.