A 64-Year-Old Man Comes to the Office for a Routine

question 767

Multiple Choice

A 64-year-old man comes to the office for a routine follow-up.  He has no current concerns.  Last year, he underwent a transthoracic echocardiogram for a cardiac murmur and was diagnosed with mild calcific aortic stenosis.  The mean gradient across the valve was 18 mm Hg (normal <5 mm Hg) , and the estimated valve area was 1.6 cm² (normal 3-4 cm²) .  The patient does not use tobacco, alcohol, or illicit drugs.  He jogs and bikes 3 times a week.
Blood pressure is 136/78 mm Hg, and pulse is 77/min and regular.  BMI is 29 kg/m².  A 3/6 systolic ejection-type murmur is heard at the upper sternal border radiating to the carotids.  S4 is heard at the apex at end-expiration.  Lungs are clear to auscultation.  The remainder of the examination is unremarkable.
ECG shows normal sinus rhythm with voltage criteria for left ventricular hypertrophy and nonspecific ST segment changes.
Laboratory results are as follows:
What is the best next step in management of this patient?

• A)Addition of beta blocker
• B)Education about antibiotic prophylaxis
• C)No intervention and clinical follow-up in a year
• D)Transthoracic echocardiogram
• E)Treadmill exercise testing

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