Valvular Heart Disease Management Flashcards
7 cards from real ITE practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Valvular Heart Disease Management flashcards as text
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?
Answer: Reassurance and follow-up with periodic echocardiography
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.
Which of the following patients with severe aortic stenosis requires concurrent coronary artery bypass grafting (CABG) at the time of surgical AVR?
Answer: Patient with coronary stenosis of 70% in the LAD
Concomitant CABG is recommended for significant CAD (≥70% stenosis in major coronary arteries) at the time of AVR to reduce perioperative MI risk.
Which anticoagulation regimen is recommended for a patient with a bileaflet mechanical aortic valve prosthesis with no additional risk factors?
Answer: Warfarin with INR target 2.0-3.0
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.
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?
Answer: Metoprolol or diltiazem
Beta-blockers (metoprolol) or non-dihydropyridine calcium channel blockers (diltiazem, verapamil) are preferred for ventricular rate control in AF with mitral stenosis.
What is the most common cause of acquired mitral stenosis in adults in the United States?
Answer: Rheumatic heart disease
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.
A 77-year-old with symptomatic severe tricuspid regurgitation secondary to RV pacing lead has LVEF 65% and no significant left-sided disease. He is high surgical risk. What is the appropriate next step?
Answer: Transcatheter tricuspid valve intervention
Transcatheter tricuspid valve interventions (e.g., TRILUMINATE, CLASP) are emerging as options for high-surgical-risk patients with severe symptomatic TR.
Which physical exam finding is most characteristic of severe aortic regurgitation?
Answer: Wide pulse pressure with bounding/water-hammer pulse
Severe AR causes volume overload of the LV, producing a wide pulse pressure (elevated systolic, low diastolic) and a bounding, collapsing (water-hammer) pulse.