Patient handout

Aortic stenosis (calcific + bicuspid + rheumatic; high-gradient & low-flow/low-gradient)

PRODUCTION

1. Your condition

This handout is for aortic stenosis (calcific + bicuspid + rheumatic; high-gradient & low-flow/low-gradient). Your care team identified this based on: classic as triad — exertional syncope, angina, or hf (2020 acc/aha vhd §3.2).

Other reasons your team may use this plan: progressive dyspnea on exertion in known as (2020 acc/aha vhd §3.2); late-peaking systolic ejection murmur with diminished/absent a2 (etchells jama 1997 pmid 9032164); incidental severe as on screening echo (2020 acc/aha vhd §3.2.3).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
clinical surveillance (no AS-directed pharmacotherapy)	—	—	—	No drug slows AS: SEAS AVR HR 1.00 (0.84–1.18) PMID 18765433; ASTRONOMER annualised peak-gradient rise 6.3 vs 6.1 mmHg/y P=0.83 PMID 20048204; SALTIRE no effect PMID 15944423. Surveillance TTE q1–2 y (moderate) per 2020 ACC/AHA VHD §3.2.5
atorvastatin	40–80 mg	PO	once daily	For independent ASCVD risk ONLY — does NOT slow AS (SEAS ischaemic-event HR 0.78 (0.63–0.97) reflects ASCVD benefit, AS-event HR 1.00; PMID 18765433)

Plan: AS severity/symptom-staged management ladder (2020 ACC/AHA VHD §3.2; EARLY-TAVR/RECOVERY/AVATAR era)

3. When to call your provider

Contact your care team if any of the following happen:

New exertional symptom → urgent Heart-Team referral (Class I AVR) (2020 ACC/AHA VHD)
EARLY-TAVR/RECOVERY/AVATAR trigger met (very-severe / rapid progression / abnormal exercise test / ↑natural marker of fluid overload (BNP)) → early-intervention referral
EF <50% on surveillance echo → Class I AVR referral

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Severe AS (Vmax ≥4 m/s, MG ≥40 mmHg, AVA ≤1.0 cm²) with exertional syncope / angina / HF (2020 ACC/AHA VHD §3.2.4)
Severe AS with EF <50% with no other cause (2020 ACC/AHA VHD §3.2.4)
Hypotension or shock in critical AS (2020 ACC/AHA VHD)(life-threatening)
New high-grade AV block post-TAVR (2020 ACC/AHA VHD)
Moderate–severe paravalvular regurgitation post-TAVR/SAVR (2020 ACC/AHA VHD)

5. Follow-up

Cardiology / valve clinic; endocarditis prophylaxis after prosthetic AVR; lifestyle; vaccinations (2020 ACC/AHA VHD §3.2.5)

6. Sources

Guideline: 2020 ACC/AHA Valvular Heart Disease Guideline (current 2026; full ACC/AHA revision planned late 2026) + 2021 ESC/EACTS VHD; EARLY-TAVR-era evidence layered on