Valvular Heart Disease Management Flashcards

A 68-year-old man with severe aortic stenosis (AVA 0.7 cm², mean gradient 55 mmHg) is asymptomatic with preserved LVEF of 60%. Which management is most appropriate?

Answer: Watchful waiting with close follow-up every 6-12 months

Asymptomatic severe AS with preserved LVEF is managed with close surveillance (every 6-12 months) as intervention is deferred until symptoms develop or LVEF falls below 50%.

A 55-year-old woman with severe mitral regurgitation has progressive LV enlargement (LVESD 47 mm) but remains asymptomatic with LVEF 60%. What is the next step?

Answer: Mitral valve repair or replacement

In chronic severe MR, surgery is indicated when LVESD reaches ≥40 mm (Class IIa) or ≥45 mm (Class I) even without symptoms, as irreversible LV dysfunction can develop.

Which finding on echocardiography is most consistent with severe mitral stenosis?

Answer: Mitral valve area of 1.0 cm²

Severe mitral stenosis is defined by an MVA ≤1.5 cm², with very severe disease defined as MVA ≤1.0 cm².

A 72-year-old with severe symptomatic aortic regurgitation and LVEF of 45% declines surgery. Which medication is most appropriate to reduce afterload?

Answer: Nifedipine or ACE inhibitor

Vasodilators (long-acting nifedipine, ACE inhibitors, or ARBs) reduce afterload and are indicated in symptomatic severe AR when surgery is not an option or as a bridge.

A 48-year-old woman with rheumatic mitral stenosis (MVA 1.2 cm²) develops symptomatic dyspnea. Echo shows pliable leaflets, no significant MR, and no left atrial thrombus. What is the preferred intervention?

Answer: Percutaneous mitral balloon commissurotomy (PMBC)

PMBC is the procedure of choice for symptomatic moderate-severe MS with favorable valve morphology (pliable leaflets, minimal calcification, no significant MR, no LA thrombus).

Which of the following valvular conditions most commonly causes a late-peaking systolic murmur heard best at the right upper sternal border that radiates to the carotids?

Answer: Aortic stenosis

Severe aortic stenosis produces a harsh, late-peaking crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotids; the later the peak, the more severe the stenosis.

A patient with a mechanical mitral valve prosthesis becomes pregnant. Which anticoagulation strategy is associated with the lowest risk of valve thrombosis?

Answer: Warfarin throughout pregnancy

Warfarin throughout pregnancy offers the most reliable anticoagulation for mechanical valves and the lowest thrombosis risk, though it carries fetal risks (especially in the first trimester).