Question 1

Question

A 72-year-old man with severe aortic regurgitation and compensated heart failure is being evaluated for surgical intervention. His echocardiogram shows LV end-diastolic dimension of 7.5 cm, ejection fraction of 45%, and severe aortic regurgitation with a regurgitant fraction of 60%. Pressure-volume loop analysis shows a markedly widened loop with increased stroke work. Evaluate the compensatory mechanisms maintaining his cardiac output and predict the timing for surgical intervention based on cardiac cycle mechanics.

Accepted Answer

Surgery is indicated now because the increased stroke work indicates the ventricle is operating at near-maximal preload reserve with impending decompensation despite preserved ejection fraction

Answer

Surgery should be delayed until ejection fraction falls below 35% because current compensatory mechanisms are adequate as evidenced by maintained cardiac output

Answer

Surgery is contraindicated due to excessive left ventricular dimensions indicating irreversible remodeling with poor surgical outcomes

Answer

Medical management with vasodilators should continue indefinitely because reduced afterload optimizes the pressure-volume relationship

Answer

Surgery should wait until symptoms develop because pressure-volume loop changes alone do not predict outcomes in valvular disease

Cardiac cycle — MCQs

Cardiac cycle — MCQs

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