Eidgenössisches Examen Humanmedizin Practice Questions - Eidgenössische Prüfung In Humanmedizin Examen Fédéral En Médecine Humaine Exam

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A 78-year-old woman presents with progressive exertional dyspnea and two recent episodes of presyncope while walking uphill. Cardiac auscultation reveals a harsh, crescendo-decrescendo systolic ejection murmur at the right upper sternal border radiating to the carotids, accompanied by a delayed and diminished carotid pulse (pulsus parvus et tardus) and a single soft second heart sound (S2). Transthoracic echocardiography shows a calcified trileaflet aortic valve with a peak transvalvular jet velocity of 4.4 m/s, mean pressure gradient of 48 mmHg, and an aortic valve area (AVA) of 0.7 cm². What is the definitive management of choice?

Aortic valve replacement (transcatheter aortic valve implantation [TAVI] or surgical aortic valve replacement [SAVR]) after Heart Team evaluation Long-term medical therapy with high-dose loop diuretics and ACE inhibitors without procedural intervention Percutaneous balloon aortic valvuloplasty as definitive lifelong corrective therapy Prescription of beta-blockers and reassurance with repeat echocardiography in 12 months

Correct Answer:

Aortic valve replacement (transcatheter aortic valve implantation [TAVI] or surgical aortic valve replacement [SAVR]) after Heart Team evaluation

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