Cardiology>>>>>Heart Failure
Question 2#

An 80 year old woman is admitted with acute pulmonary oedema on a background of progressive shortness of breath with exertional chest pain for 6 months. She has a history of renal impairment with an eGFR of 40 mL/min. She is initially commenced on IV furosemide with good effect. An echocardiogram reveals LVEF 40% with severe aortic stenosis (AS) with an estimated valve area of 0.7 cm2 .

What would you do next?

A. Add a beta-blocker
B. Perform angiography with a view to aortic valve replacement (AVR)/transcatheter aortic valve implantation
C. Add an ACE inhibitor
D. Implant a CRT-D
E. A and B

Correct Answer is E


The patient has severe AS; therefore an ACE inhibitor is contraindicated. Symptoms are probably due to AS and therefore further investigation is needed to assess for AVR. Angina symptoms should be treated with a BB in the interim. CRT-D is not indicated as severe AS needs addressing and EF is not less than 35% (NICE Guidelines).