When should a patient with aortic valve (AV) stenosis be seen by a cardiologist?

From the Guidelines

A patient with aortic valve stenosis should be referred to a cardiologist as soon as the condition is suspected or diagnosed, regardless of symptom severity. This is because aortic stenosis is a progressive condition that can lead to severe complications, including sudden cardiac death, if left untreated or undertreated 1. Patients with mild stenosis typically need follow-up every 3-5 years, moderate stenosis every 1-2 years, and severe stenosis every 6-12 months. Immediate cardiologist evaluation is necessary for patients who develop symptoms such as chest pain, shortness of breath, dizziness, or syncope, as these indicate disease progression and increased risk of sudden cardiac death 1.

Key Considerations

• Early referral to a cardiologist is crucial to prevent complications and improve outcomes
• Comprehensive evaluations, including echocardiography, are necessary to assess stenosis severity and determine appropriate monitoring intervals
• Intervention, typically surgical valve replacement or transcatheter aortic valve implantation, is generally recommended for severe symptomatic stenosis or asymptomatic severe stenosis with certain high-risk features 1
• Regular cardiologist follow-up is essential to monitor disease progression and adjust treatment plans as needed

Monitoring and Treatment

• Patients with severe aortic stenosis should be evaluated by a cardiologist every 6-12 months
• Those with symptomatic severe stenosis or asymptomatic severe stenosis with high-risk features should be considered for intervention
• The decision to perform surgical aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI) should be made by a multidisciplinary team, including a cardiologist and cardiothoracic surgeon 1

Importance of Early Detection

• Early detection of worsening aortic stenosis can significantly improve outcomes and quality of life
• Regular follow-up with a cardiologist can help identify disease progression and allow for timely intervention
• Aortic stenosis is a progressive condition, and timely intervention can prevent complications and improve outcomes 1

From the Research

When to See a Specialist for Aortic Valve Stenosis

A patient with aortic valve (AV) stenosis should be seen by a cardiologist in the following situations:

• Symptomatic severe aortic stenosis: patients with symptoms such as heart failure, angina, or syncope should be considered for aortic valve replacement 2, 3
• Asymptomatic severe aortic stenosis: patients with severe aortic stenosis without apparent symptoms should be referred to a cardiologist for further evaluation and consideration of aortic valve replacement 3
• Left ventricular systolic dysfunction: patients with left ventricular systolic dysfunction should be referred to a cardiologist for further evaluation and consideration of aortic valve replacement 3
• Moderate aortic stenosis with symptoms: patients with symptomatic moderate aortic stenosis should be referred to a cardiologist for further evaluation and consideration of aortic valve replacement 3

Importance of Early Referral

Early referral to a cardiologist is crucial for patients with aortic valve stenosis, as it allows for timely evaluation and treatment, which can improve outcomes 4, 5. Delaying referral can lead to a higher risk of complications and mortality.

Factors Influencing Referral

The decision to refer a patient to a cardiologist is influenced by several factors, including:

• Patient symptoms and severity of aortic stenosis
• Presence of comorbidities
• Patient preference and reluctance to undergo surgery
• Physician reluctance to offer aortic valve replacement
• Availability of specialized valve clinics and interdisciplinary team discussions between cardiologists and surgeons 4, 5