Sponsored Links
Results 1 to 3 of 3

Thread: Cardio#4

  1. #1
    IMG SURVIVOR's Avatar
    IMG SURVIVOR is offline Moderator 536 points
    Join Date
    Jan 2006
    Location
    NY
    Posts
    5,842
    Downloads
    43
    Uploads
    0
    Blog Entries
    29
    Thanks
    0
    Thanked 0 Times in 0 Posts

    Cardio#4

    Advertisements



    A 71-year-old man is being evaluated for symptoms of congestive heart failure. On physical examination, the left ventricular point of maximum impulse is enlarged and displaced laterally. Cardiac auscultation shows a crescendo-decrescendo systolic murmur at the right upper sternal border, peaking in the latter half of systole. Echocardiography with Doppler shows left atrial and left ventricular enlargement and global left ventricular hypokinesis, with an estimated left ventricular ejection fraction of 20% to 25%. The aortic valve has heavy calcification, with diminished cusp mobility. The mean and peak pressure gradients in the aortic valve are 16 mm Hg and 26 mm Hg, respectively. Which of the following tests should be performed next?
    A. Transesophageal echocardiography
    B. Exercise stress test with electrocardiogram
    C. Dobutamine stress echocardiography
    D. Adenosine myocardial perfusion scintigraphy
    Moderator: USMLE AND Residency Forums.

    Hidden Content
    why even bother with the obvious. Just know where you are need it and where you can help the most.

  2. #2
    blackwolverine is offline Junior Member 510 points
    Join Date
    Dec 2005
    Posts
    21
    Downloads
    77
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts
    D????? i think

  3. #3
    IMG SURVIVOR's Avatar
    IMG SURVIVOR is offline Moderator 536 points
    Join Date
    Jan 2006
    Location
    NY
    Posts
    5,842
    Downloads
    43
    Uploads
    0
    Blog Entries
    29
    Thanks
    0
    Thanked 0 Times in 0 Posts
    The correct answer is C
    Educational Objectives
    Evaluate a patient with aortic stenosis with concomitant cardiomyopathy.
    critique
    This patient has symptoms of congestive heart failure and evidence of aortic valve calcification, but low transvalvular gradients. Because gradients are dependent on flow, this patients gradients may be low as a result of severe left ventricular systolic dysfunction despite severe aortic stenosis.
    Left ventricular systolic dysfunction is associated with increased perioperative risk in patients who have aortic stenosis. Some patients have a very poor prognosis after aortic valve replacement. In others, the prognosis is greatly improved after surgery. Dobutamine stress echocardiography is useful in patients who have left ventricular systolic dysfunction, aortic stenosis, and low transvalvular gradients. An increase in aortic gradients in the setting of systolic augmentation of the left ventricle suggests that aortic stenosis is severe and that the low gradients can be attributed to low flow across the valve as a result of cardiomyopathy. Conversely, left ventricular contractile reserve without an increase in gradients suggests that, despite calcification of the valve, stenosis is not severe.

    Contractile reserve in the setting of severe aortic stenosis suggests a better prognosis with aortic valve replacement than with medical therapy, whereas absence of contractile reserve suggests a poor prognosis after aortic valve replacement. Although transesophageal echocardiography allows excellent visualization of the valve, it does not allow determination of left ventricular contractile reserve. Exercise testing is usually contraindicated in patients who have severe symptomatic aortic stenosis. Its use as a tool to assess contractile reserve has not been validated in patients with aortic stenosis.
    Myocardial perfusion imaging does not allow assessment of left ventricular contractile reserve or the severity of aortic stenosis.

    Moderator: USMLE AND Residency Forums.

    Hidden Content
    why even bother with the obvious. Just know where you are need it and where you can help the most.

Similar Threads

  1. Cardio#5
    By IMG SURVIVOR in forum Pathology Forum
    Replies: 4
    Last Post: 06-05-2009, 04:37 PM
  2. Hy 2545 Cardio Cardio Cardio!
    By tommyk in forum USMLE Step 1 Forum
    Replies: 0
    Last Post: 10-30-2006, 04:12 AM
  3. Cardio Q-1
    By Roxanita in forum Pathology Forum
    Replies: 4
    Last Post: 09-07-2005, 04:37 AM
  4. cardio 3
    By Asclepius1 in forum USMLE Step 1 Chats
    Replies: 0
    Last Post: 04-26-2005, 08:40 PM
  5. cardio 2
    By Asclepius1 in forum USMLE Step 1 Chats
    Replies: 0
    Last Post: 04-25-2005, 08:53 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •