ITE Valvular Heart Disease Management 2

Question 1

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?

Accepted Answer

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

Answer

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%.

Question 2

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?

Accepted Answer

Mitral valve repair or replacement

Answer

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.

Question 3

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

Accepted Answer

Mitral valve area of 1.0 cm²

Answer

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

Question 4

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

Accepted Answer

Nifedipine or ACE inhibitor

Answer

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.

Question 5

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?

Accepted Answer

Percutaneous mitral balloon commissurotomy (PMBC)

Answer

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).

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Valvular Heart Disease Management 2