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250 words, APA style, it needs a reference not a bibliography
Question: Does my patient have significant aortic stenosis?
A 72 year-old woman with a history of CHF presents with several weeks of gradually progressive dyspnea on exertion (DOE). At her baseline, she is able to walk several blocks, but now feels winded. She denies chest pain, palpitations, syncope/near syncope, cough, orthopnea, or PND. She states she is compliant with her medications and diet. She has had a recent functional study that showed minimal ischemia.
Meds
aspirin
digoxin 0.125 qd
lisinopril 20 mg qd
furosemide 20 mg qd
KCl 10 mEq qd
PE
HR 90, regular
PB 134/70
Labs
chem 7:
Na 132
K 5
Cl 94
HCO3 30
BUN 18
Cr 1.3
CBC: notable for Hgb 14 g/dL (Hct 43%)
CV
RRR, normal S1 and S2
No S3 but has S4
2/6 mid-peaking systolic murmur at the LUSB that radiates to the carotids.
PMI is mildly enlarged and sustained
Neck
Carotid pulse is brisk.
JVP flat
Positive abdominojugular reflux
CXR
Xray shows cardiomegaly and mild vascular redistribution
ECG
Unchanged with an incomplete LBBB pattern
Clinical Diagnosis
Worsening of her congestive heart failure (positive AJR, enlarged and sustained PMI, cardiomegaly, and vascular redistribution).
Clinical Questions
Is this patient’s worsening CHF due to significant aortic stenosis?
Please elaborate why you think it may be aortic stenosis according to patient’s symptoms and how do you assess each symptom.

Struggling with where to start this assignment? Follow this guide to tackle your assignment easily!

Step-by-Step Guide

1. Understand the Assignment Requirements:
   • Identify the focus of the question: Determine if aortic stenosis is contributing to this patient’s worsening CHF and evaluate her symptoms systematically.
2. Organize Your Approach:
   • Divide the analysis into the following sections:
     • Symptoms of aortic stenosis.
     • Physical exam findings.
     • Diagnostic tools to confirm AS.
3. Begin with the Symptoms:
   • Highlight the patient’s progressive DOE.
   • Discuss why the absence of chest pain or syncope does not rule out AS.
   • Correlate symptoms like worsening CHF and AJR to potential left ventricular dysfunction due to AS.
4. Assess the Physical Exam Findings:
   • Explain the significance of the mid-peaking systolic murmur, its radiation to the carotids, and the brisk carotid pulse.
   • Discuss the S4 sound and how it relates to LVH and diastolic dysfunction.
5. Incorporate Diagnostic Data:
   • Mention relevant imaging (e.g., CXR findings of cardiomegaly) and ECG evidence of incomplete LBBB.
   • Emphasize the role of echocardiography in quantifying the severity of AS and assessing the transvalvular gradient.
6. Write the Draft:
   • Start with a clear introduction summarizing the clinical scenario.
   • Discuss each symptom and diagnostic clue in relation to AS.
   • Conclude with the importance of echocardiography and its role in guiding further management.
7. Edit and Finalize:
   • Revise for clarity, conciseness, and coherence.
   • Ensure all terms are explained for non-specialist readers.

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