A 56-year-old man with long-standing hypertension presents with dyspnea on exertion. On examination, the carotid pulse has a slow rise and small amplitude. A systolic ejection murmur is heard at the right upper sternal border. Echocardiography shows a peak gradient of 65 mmHg across the aortic valve. Which of the following is the most appropriate next management step?
- A)Observation with serial echocardiography
- B)Aortic valve replacementGABARITO
- C)Dobutamine stress testing
- D)Beta-blocker therapy
- E)Cardiac catheterization for pressure measurements
Explicação
This patient has severe aortic stenosis (peak gradient 65 mmHg, normal <20 mmHg; severe >50 mmHg) with symptoms (dyspnea on exertion). Aortic valve replacement is indicated in symptomatic severe aortic stenosis. The slow-rising carotid pulse (parvus et tardus)... Ver explicação completa e trilha adaptativa →