Systolic ejection click

Specialty: Cardiovascular.

• ejection systolic click
• valve ejection click

Why it occurs

• Congenital or calcified valvular aortic stenosis (with flexible leaflets)
• Congenital valvular pulmonary stenosis
• Idiopathic dilation of the aortic root or pulmonary artery
• Nonstenotic bicuspid aortic valve
• Severe systemic arterial hypertension with dilation of the ascending aorta

Initial workup

Two-dimensional transthoracic echocardiogram and color Doppler to definitively evaluate the valve anatomy (presence of bicuspid valve), quantify the area of ​​the aortic or pulmonary valve, measure the mean and maximum transvalvular gradient, and assess the degree of secondary left ventricular hypertrophy and systolic function; 12-lead electrocardiogram; Multidetector computed tomography of the aorta to accurately measure the diameter of the aortic root and ascending aorta in suspected ectasia or aneurysm associated with a bicuspid valve.

Standard management

• Metoprolol succinate — beta blocker indicated if there is associated aortic root dilation to reduce shear force on the aortic wall; 25 to 50 mg once daily orally, titrated according to heart rate and blood pressure
• Losartan — angiotensin II receptor antagonist for tension control and limitation of dilation of the ascending aorta in patients with bicuspid aortic valve; 50 mg once a day orally
• Rosuvastatin — statin for strict control of the lipid profile in the presence of degenerative valve calcification or associated atherosclerosis; 10 to 20 mg at night orally
• Furosemide (use with extreme caution and in low doses in case of severe symptomatic aortic stenosis with pulmonary congestion, due to the risk of severe hypotension due to preload dependence; 10 to 20 mg orally).