How is hypotension best treated in the patient with aortic stenosis?

How is hypotension best treated in the patient with aortic stenosis?

Patients with severe AS do not tolerate hypotension, and even brief episodes may lead to hemodynamic decompen-sation. The determinants of cardiac output are preload, afterload, heart rate, and contractility (Table 5.1). The pri-orities of treatment should be the following:

·        preservation of blood pressure using vasoconstrictors to increase afterload

·        restoration of sinus rhythm and intravenous fluids to maintain preload

·        maintaining a heart rate in the normal range

·        maintenance of myocardial contractility

Treatment of Supraventricular Dysrhythmias

Tachydysrhythmias

Therapeutic diagnostic maneuvers

Vagal maneuvers

Adenosine

Treatment

β-Adrenergic blockers

Amiodarone

Cardioversion

Bradydysrhythmias

Anticholinergics

      α- and β-adrenergic agonists

      Atrioventricular sequential pacing

If the etiology is not immediately obvious, then empiric treatment with an α-adrenergic receptor agonist (phenyle-phrine) should be attempted. The goal is to preserve CPP so that the heart does not enter a vicious cycle of irre-versible ischemia. In general, pure α-adrenergic receptor agonists are the preferred vasoconstrictor agents because they do not cause tachycardia. In this way, the CPP is increased and diastolic filling time is maintained