小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 劳力性呼吸困难
- 疲劳
- 胸痛
- 运动性晕厥
- 收缩期喷射性杂音
- 第二心音减弱，呈单心音
- 颈动脉细迟脉
其他诊断因素
- S2 逆分裂
- Gallavardin 现象
- 出血
危险因素
- 年龄 60 岁以上
- 先天性双瓣膜主动脉瓣
- 风湿性心脏病
- 慢性肾病
- 放疗
- 低密度脂蛋白（low-density lipoprotein, LDL）胆固醇水平高
- 高脂蛋白血症
- 高血压
- 糖尿病
- 脂蛋白 (a) 水平升高
- 家族史
- 肥胖
诊断性检查
首要检查
- 心电图（ECG）
- 经胸超声心动图 (TTE)
- 胸部 X 线检查
需考虑的检查
- 心脏计算机体层成像（CT）
- 心脏磁共振成像
- CT 血管造影术
- 磁共振血管成像
- 心电图运动负荷试验
- 多巴酚丁胺负荷超声
- 经食管超声心动图（TOE）
- 心导管检查
治疗流程
临床情况不稳定
临床稳定：有症状
临床稳定：无症状
撰稿人
作者
Matthew Czarny, MD
Assistant Professor of Medicine
Department of Cardiovascular Medicine
Johns Hopkins University School of Medicine
Baltimore
MD
利益声明
MC declares their institution receives research funding from Medtronic, Abbott, Edwards Lifesciences, and V-Wave Medical.
Rani Hasan, MD
Assistant Professor of Medicine
Department of Cardiovascular Medicine
Johns Hopkins University School of Medicine
Baltimore
MD
利益声明
RH declares that he has no competing interests.
鸣谢
Dr Matthew Czarny and Dr Rani Hasan would like to gratefully acknowledge Dr Girish L. Kalra and Dr Vasilis Babaliaros, previous contributors to this topic.
利益声明
GLK declares that he has no competing interests. VB is a co-investigator in the PARTNER trial, and he has served as a consultant for Edwards Lifesciences and Abbott Vascular.
同行评议者
Peter Block, MD
Professor of Medicine
Emory University School of Medicine
Atlanta
GA
利益声明
PB declares that he has no competing interests.
Ghada Mikhail, BSc, MD, FRCP
Consultant Cardiologist and Honorary Senior Lecturer
Imperial College Healthcare NHS Trust
Hammersmith Hospital
London
UK
利益声明
GM has been supported by Edwards Lifesciences (manufacturer of the Edwards Sapien Transcatheter Valve) for attending cardiology conferences. Both Edwards Lifesciences and Medtronic (manufacturer of the CoreValve Transcatheter Valve) are contributing to an educational course on the transcatheter and surgical treatments of aortic and mitral valve disease. Edwards Lifesciences are supporting a research project on transcatheter treatment of aortic valve disease.
Juan M. Sztajzel, MD
Consultant
Cardiology Center
University Hospital Geneva
Geneva
Switzerland
利益声明
JMS declares that he has no competing interests.
鉴别诊断
- 主动脉硬化
- 缺血性心脏病
- 肥厚型心肌病 (Hypertrophic cardiomyopathy, HCM)
更多 鉴别诊断指南
- 成人心脏瓣膜病：检查与管理
- 心脏瓣膜病患者管理指南
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