FCP(SA) Part II Practice Questions - Fellowship Of The College Of Physicians Of South Africa Part II Exam

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A 74-year-old female presents with progressive exertional angina and presyncope. Echocardiography demonstrates a calcified aortic valve with an aortic valve area (AVA) of 0.7 cm², a mean transvalvular gradient of 28 mmHg, and a left ventricular ejection fraction (LVEF) of 32%. A low-dose dobutamine stress echocardiogram is performed. Which of the following findings confirms true severe low-flow, low-gradient aortic stenosis?

Increase in mean gradient to 30 mmHg and AVA increase to 1.3 cm² with increased stroke volume Increase in mean gradient to >= 40 mmHg with AVA remaining <= 1.0 cm² as stroke volume increases No change in stroke volume, mean gradient, or AVA despite maximum dobutamine infusion Decrease in mean gradient below 20 mmHg with an increase in LVEF to 55%

Correct Answer:

Increase in mean gradient to >= 40 mmHg with AVA remaining <= 1.0 cm² as stroke volume increases

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