11-28-2007, 09:09 AM
An 80-year-old male presents to your clinic with a 5-month history of progressive
shortness of breath, dyspnea on exertion, orthopnea, and lower extremity edema. He
notes "chest pressure" while walking up a flight of stairs that is relieved with rest. He
denies any episodes of syncope but has felt "dizzy" at various times over the last 2
months. On exam, jugular venous pressure is elevated. There is an audible grade IV
systolic ejection murmur heard at the base with radiation to the carotid arteries. There
are bibasilar crackles and pitting edema. An electrocardiogram shows evidence of left
ventricular hypertrophy. You order an echocardiogram, which shows a stenotic, calcified
aortic valve with an estimated valve area of 0.7 cm2 with an elevated transvalvular
gradient. Ejection fraction is estimated at 40%. What management step should you
recommend to improve his long-term survival?
A. Furosemide
B. Atorvastatin
C. Nitroglycerin
D. Aortic valve replacement
E. Balloon valvuloplasty
shortness of breath, dyspnea on exertion, orthopnea, and lower extremity edema. He
notes "chest pressure" while walking up a flight of stairs that is relieved with rest. He
denies any episodes of syncope but has felt "dizzy" at various times over the last 2
months. On exam, jugular venous pressure is elevated. There is an audible grade IV
systolic ejection murmur heard at the base with radiation to the carotid arteries. There
are bibasilar crackles and pitting edema. An electrocardiogram shows evidence of left
ventricular hypertrophy. You order an echocardiogram, which shows a stenotic, calcified
aortic valve with an estimated valve area of 0.7 cm2 with an elevated transvalvular
gradient. Ejection fraction is estimated at 40%. What management step should you
recommend to improve his long-term survival?
A. Furosemide
B. Atorvastatin
C. Nitroglycerin
D. Aortic valve replacement
E. Balloon valvuloplasty