A 70-Year-Old Man Is Brought to the Emergency Department by His

question 400

Multiple Choice

A 70-year-old man is brought to the emergency department by his wife after an episode of syncope while working in his garden.  He regained consciousness immediately and initially refused to go to the hospital saying, "I feel fine."  The patient has never experienced syncope before.  According to his wife, he has always been physically active but lately has had increased fatigability; he seems to work less in the garden and spends more time indoors watching television.  Medical history is significant for type 2 diabetes mellitus and gout.  His only current medication is metformin.  He is a lifetime nonsmoker and does not drink alcohol.  Blood pressure is 100/80 mm Hg and pulse is 90/min.  BMI is 28 kg/m².  Both carotid pulses are delayed.  Lungs are clear on auscultation.  A harsh crescendo-decrescendo murmur is heard at the base of the heart.  The second heart sound is soft with an inaudible A2 component.  There is no peripheral edema.  ECG shows normal sinus rhythm, left ventricular hypertrophy, and secondary ST-segment and T-wave changes.  Echocardiography shows concentric left ventricular hypertrophy with severe calcification of the aortic valve.  The estimated aortic valve area is 0.78 cm² and the mean transvalvular gradient is 50 mm Hg.  Laboratory studies show normal complete blood count and serum creatinine of 0.8 mg/dL.  Which of the following is the best statement about this patient's condition?

• A)Aortic valve replacement is associated with marked reduction in mortality
• B)Balloon valvulotomy is preferred due to better long-term prognosis
• C)Balloon valvulotomy is preferred due to low procedural morbidity
• D)Conservative treatment should be tried before offering an intervention
• E)The patient's onset of symptoms has minimal bearing on his prognosis

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Definitions:

NLRA Coverage

Refers to the scope of businesses and workers protected under the National Labor Relations Act, which governs labor relations in the United States, including rights to organize and collective bargaining.

Opt Out Approach

A policy or system where individuals are assumed to be participants unless they choose to opt-out or decline participation.

Certification Election

A formal process through which employees vote to accept or reject representation by a labor union.

Performance Strike Replacements

Workers who are hired to take over the duties of striking employees with the focus on maintaining productivity.