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Aortic Valve Velocity ≥ 4m/sec?
OR
Mean gradient ≥ 40mmHg

Yes No

Aortic Valve Area < 1cm²?

Yes No

Dx: Severe Aortic Stenosis

Does the patient have symptoms?

Yes No

Look for anemia, high output state, severe aortic regurgitation

Ejection Fraction > 50%?

Yes No

Peak Velocity > 5m/sec?

Yes No

Consider Aortic Valve Replacement

Consider Stress Test
OR
Follow-up every 6-12 months

Dx: Progressive Aortic Stenosis

Does the patient have symptoms?

Yes No

Dx: Low Output Low Gradient Aortic Stenosis

Ejection Fraction > 50%?

Yes No

Followup

Aortic Valve Velocity 3-4 m/sec?

Yes No

Followup every 3-5 years.

Followup every 1-2 years.

Dx: Low output with Low Ejection Fraction

Consider Dobutamine Test.

Further evaluation needed.

Dx: Low Output Aortic Stenosis with preserved Ejection Fraction

Further evaluation needed (may benefit from Aortic Valve Replacement).

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