06-24-2008, 11:24 PM
A 54-year-old man from Thailand presents to your office complaining of occasional shortness of breath. He claims that the shortness of breath occurs shortly after having intercourse with his wife. He denies any chest pain, nausea, vomiting, or diaphoresis. He also denies hemoptysis or palpitations. He claims that be has been married for 30 years and he has noticed this shortness of breath increasing in frequency over the past year. He denies any medical history and denies taking any medications. On examination, the patient is noted to have a diastolic murmur, best heard in the left lateral recumbent position. The remainder of the exam is unremarkable. The patient is sent for transthoracic echocardiogram, which reveals a mitral area of 1.8 cm2 with a transmitral gradient of 3 mm Hg. No left atrial enlargement or thrombus is seen. What is the next best step in the management of this patient?
(A) Transesophageal echocardiogram (TEE)
(B) Cardiac catheterization
© Echo-stress test
(D) Start the patient on atenolol 25 mg daily
(E) Schedule patient for valvulotomy
(A) Transesophageal echocardiogram (TEE)
(B) Cardiac catheterization
© Echo-stress test
(D) Start the patient on atenolol 25 mg daily
(E) Schedule patient for valvulotomy