Afghanistan Comprehensive Specialization Exam Practice Questions - Afghanistan Comprehensive Specialization Completion Exam (Takhasus) Exam

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A 52-year-old male with a history of bicuspid aortic valve presents to the resuscitation bay with sudden-onset excruciating 'tearing' chest pain radiating directly into the interscapular region. His blood pressure is 88/54 mmHg in the right arm and 84/50 mmHg in the left arm, with a heart rate of 118 bpm. Cardiac examination reveals distant heart sounds, jugular venous distention, and a new high-pitched decrescendo diastolic murmur at the right sternal border. Point-of-care transthoracic echocardiography demonstrates an intimal flap in the ascending aorta, severe aortic regurgitation, and a 1.2 cm pericardial effusion without frank diastolic right ventricular collapse. What is the immediate, most appropriate definitive management step?

Immediate emergent cardiothoracic surgical consultation for ascending aortic repair and valve replacement/resuspension Immediate bedside subxiphoid pericardiocentesis under ultrasound guidance to evacuate the hemopericardium Administration of high-dose intravenous beta-blocker (esmolol) to achieve target systolic blood pressure < 100 mmHg Emergent transfer to the catheterization laboratory for transcatheter aortic valve implantation (TAVI)

Correct Answer:

Immediate emergent cardiothoracic surgical consultation for ascending aortic repair and valve replacement/resuspension

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