A patient with aortic stenosis has been asymptomatic for decades. He states he has some dizziness associated with activity but no chest pain or shortness of breath. What is the best course of action?

In a patient with aortic stenosis who is experiencing symptoms such as dizziness, it is vital to take their condition seriously. Aortic stenosis can remain asymptomatic for a long period, but the development of symptoms, even mild ones like dizziness with activity, indicates that the condition may be progressing. This symptomatic presentation raises the concern for potential complications, including heart failure or arrhythmias.

Referring the patient to cardiology is the most appropriate course of action. A cardiologist can conduct a thorough evaluation, including recommending further imaging studies such as echocardiograms to assess the severity of the stenosis and the impact on cardiac function. The cardiologist may also consider the timing of surgical intervention, such as aortic valve replacement, if necessary. Regular follow-ups alone or starting beta-blocker therapy without a definitive assessment of the stenosis can lead to inadequate management of the condition.

Immediate management requires expert evaluation to ensure that the patient receives the appropriate care, given the risks associated with symptomatic aortic stenosis.