WBR0840
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| Author | Neeraja Danda M.B.B.S |
|---|---|
| Exam Type | USMLE Step 2 CK |
| Main Category | Internal medicine |
| Sub Category | Cardiovascular |
| Prompt | A 68 year old male presents to the office with complaint of episodes of loss of consciousness. The loss and regaining of consciousness was sudden in all episodes. On auscultation there is a murmur in the right second intercostal space which increases and then decreases in intensity during systole. Electrocardiogram and chest X ray show changes consistent with left ventricular hypertrophy.What is the definitive treatment for this patient’s condition? |
| Answer A | Diuretics |
| Answer A Explanation | Incorrect Diuretics can be given to decrease the after load, but it is not the definitive treatment. |
| Answer B | Transthoracic echocardiogram |
| Answer B Explanation | Incorrect It is the best initial test in all valvular heart diseases. |
| Answer C | Valvuloplasty |
| Answer C Explanation | Incorrect It is choice of treatment in Mitral stenosis. Valvuloplasty is not a choice of treatment in aortic stenosis, always valvular replacement is preferred. |
| Answer D | Warfarin |
| Answer D Explanation | Incorrect Warfarin can be used for anticoagulation after valve replacement. |
| Answer E | Valve replacement |
| Answer E Explanation | Valvular replacement is the definitive treatment in aortic stenosis |
| Right Answer | E |
| Explanation | The patient in this vignette presents with syncope and a heart murmur characteristic of aortic stenosis. Electrocardiogram and X-ray with left ventricular hypertrophy are also findings of consistent with aortic stenosis. Aortis stenosis in old aged patients is due to calcification of the aortic valve due to age with a mean age of 65-70 years old. Aortic stenosis can present in younger patients (40s to 50s) due to calcification of a congenital bicuspid aortic valve. The definitive treatment for this condition is valve replacement.
Educational Objective: Valvular replacement is the definitive treatment in aortic stenosis. Bioprosthetic or mechanical valves can be used. References: Page 63,64,65 Master the boards step 3 2009, Page 89 Master the boards step 2 CK second edition |
| Approved | Yes |
| Keyword | Aortic stenosis |
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