ITE Valvular Heart Disease Management 5

Question 1

A 60-year-old woman with severe functional mitral regurgitation due to dilated cardiomyopathy (LVEF 30%) has persistent NYHA class III symptoms despite optimal GDMT. Which intervention has been shown to reduce HF hospitalizations in this population?

Accepted Answer

MitraClip (transcatheter edge-to-edge repair)

Answer

The COAPT trial demonstrated that MitraClip (transcatheter TEER) significantly reduced HF hospitalizations and mortality in patients with severe secondary MR on maximally tolerated GDMT.

Question 2

A patient with rheumatic mitral stenosis is started on anticoagulation for a new LAA thrombus. After 3 months of therapeutic anticoagulation, repeat TEE shows persistent thrombus. What is the next step?

Accepted Answer

Continue anticoagulation for another 3 months and repeat TEE

Answer

If LAA thrombus persists after 3 months of therapeutic anticoagulation, extending anticoagulation for another 3 months is reasonable before reassessing suitability for PMBC.

Question 3

Which of the following is the strongest independent predictor of poor outcomes after TAVR?

Accepted Answer

Severe frailty and functional dependence

Answer

Severe frailty and functional dependence are the strongest independent predictors of poor post-TAVR outcomes, as they reflect overall physiologic reserve independent of cardiac anatomy.

Question 4

A 45-year-old man with a history of IV drug use presents with fever, bacteremia, and a new holosystolic murmur at the left lower sternal border. Echo shows a large vegetation on the tricuspid valve with severe TR. Which organism is most likely responsible?

Accepted Answer

Staphylococcus aureus

Answer

Staphylococcus aureus is the most common cause of right-sided infective endocarditis in IV drug users, particularly affecting the tricuspid valve.

Question 5

A 55-year-old with severe aortic stenosis and LVEF 25% (low-flow, low-gradient AS) has a mean gradient of 28 mmHg and AVA 0.75 cm². Dobutamine stress echo shows mean gradient increases to 52 mmHg and AVA remains 0.75 cm². What does this indicate?

Accepted Answer

True severe AS with contractile reserve—AVR is likely beneficial

Answer

An increase in mean gradient >40 mmHg with stable low AVA on dobutamine stress echo confirms true severe AS with contractile reserve, indicating likely benefit from AVR despite low LVEF.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Valvular Heart Disease Management 5