ITE Valvular Heart Disease Management 4

Question 1

A 35-year-old woman with mitral valve prolapse presents with palpitations. Echo shows classic MVP with bileaflet prolapse and mild MR. Her resting ECG shows no pre-excitation. What is the most appropriate management?

Accepted Answer

Reassurance and follow-up with periodic echocardiography

Answer

Most patients with MVP and palpitations without high-risk features (severe MR, LV dysfunction, complex ventricular ectopy, T-wave changes in inferolateral leads) require only reassurance and surveillance.

Question 2

Which of the following patients with severe aortic stenosis requires concurrent coronary artery bypass grafting (CABG) at the time of surgical AVR?

Accepted Answer

Patient with coronary stenosis of 70% in the LAD

Answer

Concomitant CABG is recommended for significant CAD (≥70% stenosis in major coronary arteries) at the time of AVR to reduce perioperative MI risk.

Question 3

Which anticoagulation regimen is recommended for a patient with a bileaflet mechanical aortic valve prosthesis with no additional risk factors?

Accepted Answer

Warfarin with INR target 2.0-3.0

Answer

For a bileaflet mechanical AVR with no additional thromboembolic risk factors, warfarin with INR target 2.0-3.0 is recommended; higher targets are needed for additional risk factors.

Question 4

A 58-year-old with severe mitral stenosis develops atrial fibrillation. Her resting ventricular rate is 110 bpm. Which is the most appropriate initial rate control agent?

Accepted Answer

Metoprolol or diltiazem

Answer

Beta-blockers (metoprolol) or non-dihydropyridine calcium channel blockers (diltiazem, verapamil) are preferred for ventricular rate control in AF with mitral stenosis.

Question 5

What is the most common cause of acquired mitral stenosis in adults in the United States?

Accepted Answer

Rheumatic heart disease

Answer

Rheumatic heart disease remains the most common cause of mitral stenosis worldwide and in the US, though calcific annular MS is increasing in the elderly population.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Valvular Heart Disease Management 4