New TAVI patient

Cardiologist Past Medical History * Hypertension, 2010 * Hypercholesterolemia, 2015 * Type 2 Diabetes Mellitus, 2018 Social History * Non-smoker * Drinks alcohol occasionally, 1-2 units per week * Lives with wife, independent in activities of daily living Family History * Father: History of coronary artery disease, died at age 72 * Mother: Alive, history of hypertension Drugs * Aspirin 75mg daily * Atorvastatin 20mg nocte * Lisinopril 10mg daily * Metformin 500mg twice daily Dear Dr. [GP's Name], It was a pleasure to review this 78-year-old patient. The patient presented with progressive shortness of breath on exertion and chest pain over the past 6 months. Symptoms have worsened recently, now experiencing shortness of breath at rest. The patient denies any recent fevers, cough, or other respiratory symptoms. The patient reports a history of intermittent claudication in the left leg, but this has not worsened recently. Examination * Blood pressure: 140/80 mmHg * Heart rate: 72 bpm, regular * Cardiac auscultation: Grade III/VI systolic ejection murmur heard best at the right upper sternal border, radiating to the carotids. * Peripheral pulses: 2+ and equal bilaterally. * No peripheral oedema. ECG: Sinus rhythm, left ventricular hypertrophy, no acute ST-T wave changes. Echo: Severe aortic stenosis (valve area 0.7 cm2, mean gradient 55 mmHg, peak gradient 75 mmHg), left ventricular hypertrophy, normal left ventricular systolic function (EF 60%). CT TAVI: Aortic valve is trileaflet, severe calcification, annulus diameter 23mm. MAC is present. Transfemoral approach is feasible. Coronary angiogram: Mild non-obstructive coronary artery disease. Impression * Severe symptomatic aortic stenosis. * The natural history of severe aortic stenosis was explained, including the risks and benefits of TAVI intervention. Plan * Discussed the case at the multidisciplinary team meeting. * Patient is suitable for TAVI. * Schedule patient for pre-TAVI assessment. * Inform the patient of the plan and obtain consent. * Follow up in 2 weeks.