Question 1

Q: A 61-year-old man presents with progressive dyspnea and fatigue. Echocardiogram shows severe aortic stenosis with valve area $0.5\mathrm{cm}^2$. He develops syncope during exercise testing. What is the most appropriate management?

Urgent aortic valve replacement. ***Urgent aortic valve replacement*** - The patient has **severe aortic stenosis** (valve area $0.5\mathrm{cm}^2$) and is highly symptomatic, indicated by **syncope during exercise**, which significantly increases the risk of sudden cardiac death. - **Aortic valve replacement (AVR)** or TAVR is the definitive and urgent treatment required for symptomatic severe AS to alleviate symptoms and improve survival. *Medical management* - Medical therapy does not treat the underlying **fixed mechanical obstruction** of the aortic valve, making it ineffective for severe symptomatic AS. - Relying solely on medical management in this scenario leads to a very poor prognosis due to the high risk of **sudden cardiac death**. *Balloon aortic valvuloplasty* - BAV is primarily a temporary measure, often used as a **bridge to AVR/TAVR** or in hemodynamically unstable patients, due to its high rate of restenosis. - Given the patient is likely a surgical candidate, BAV is not considered the **definitive long-term solution** for severe AS. *Heart transplantation* - Heart transplantation is reserved for **end-stage heart failure** that is refractory to other medical and surgical options. - The primary pathology (severe AS) is surgically addressable via AVR, making transplantation an **inappropriate** initial therapy. *ICD insertion* - Syncope in severe AS is typically due to **flow limitation** and **exertional hypotension** caused by the fixed obstruction, rather than primary ventricular tachyarrhythmias. - Treating the underlying mechanical pathology with AVR resolves the cause of the syncope and the high risk of sudden death; therefore, an **ICD is not indicated**.

Question

A 61-year-old man presents with progressive dyspnea and fatigue. Echocardiogram shows severe aortic stenosis with valve area $0.5\mathrm{cm}^2$. He develops syncope during exercise testing. What is the most appropriate management?

Accepted Answer

Urgent aortic valve replacement

Answer

Medical management

Answer

Balloon aortic valvuloplasty

Answer

Heart transplantation

Answer

ICD insertion

Cardiology — MCQs

Cardiology — MCQs

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