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Category: Critical Care Medicine-Cardiovascular Disorders--->Valvular Heart Disease
Page: 2

Question 6#Print Question

A 38-year-old female with a history of mitral valve prolapse presents to the cardiac ICU following a mitral valve repair. The intraoperative course was significant for two periods of cardiopulmonary bypass because of a failed first repair. The patient’s hemodynamics is supported with a low-dose norepinephrine infusion. Following turning the patient in bed, there is an acute decrease in blood pressure refractory to treatment with multiple boluses of norepinephrine and phenylephrine. Emergent transthoracic echocardiography at the bedside demonstrates severe right ventricular dysfunction, in addition to new onset inferior and inferoseptal wall motion abnormalities.

What is the most appropriate next step in management?

a. Left-heart catheterization
b. Preload reduction with nitroglycerin
c. Intra-aortic balloon pump
d. Epinephrine infusion


Question 7#Print Question

A 34-year-old female with a history of rheumatic heart disease presents for mitral valve replacement. Preoperative echocardiography demonstrates a transmitral gradient of 14 mm Hg, a mitral valve area of 0.9 cm2 , and an underfilled left ventricle with normal function. Electrocardiogram shows atrial fibrillation.

What is the most likely finding on postoperative transesophageal echocardiography following mitral valve replacement in this patient?

a. Decreased right ventricular function
b. Increased transpulmonary pressure gradient
c. Decreased left ventricular systolic function
d. Worsened tricuspid regurgitation


Question 8#Print Question

A 48-year-old male with a history of hypertension, patent foramen ovale, coronary artery disease, and diabetes mellitus presents with increasing shortness of breath, wheezing, peripheral edema, diarrhea, and headache. Transthoracic echocardiography shows severe tricuspid regurgitation, severe mitral regurgitation, and evidence of right ventricular failure. The subvalvular apparatus of the tricuspid and mitral valves appear thickened.

What is the likely etiology? 

a. Carcinoid heart disease
b. Endocarditis
c. Rheumatic heart disease
d. Acute inferior myocardial infarction


Question 9#Print Question

A 78-year-old female presents with a femur fracture following a fall. She is persistently hypotensive in the ICU before surgery for open reduction internal fixation. Transthoracic echocardiography demonstrates the following continuous wave Doppler waveform:

What is the most likely diagnosis?

a. Aortic stenosis
b. Subaortic membrane
c. Aortic insufficiency
d. Hypertrophic cardiomyopathy


Question 10#Print Question

A 78-year old female with severe aortic stenosis presents to the ICU following a transcatheter aortic valve replacement (TAVR). Preprocedural transthoracic echocardiography demonstrated severe aortic stenosis with left ventricular hypertrophy and an asymmetric septal bulge. Left ventricular wall thickness in the parasternal short axis view is 1.6 cm with a small cavity. Postoperatively, the patient develops sudden onset hypotension requiring vasopressor support; however, blood pressure continues to decrease despite escalating doses of norepinephrine.

The vital signs are:

  • heart rate 94 bpm
  • blood pressure 85/54 mm Hg
  • respiratory rate 18/min

 Transthoracic echocardiography demonstrates an underfilled left ventricle with midventricular obstruction.

What is the most appropriate next step in management?

a. Discontinue norepinephrine and start phenylephrine infusion
b. Discontinue norepinephrine and start epinephrine
c. Discontinue norepinephrine and start esmolol infusion
d. Discontinue norepinephrine and administer fluid bolus




Category: Critical Care Medicine-Cardiovascular Disorders--->Valvular Heart Disease
Page: 2 of 2