American Board of Family Medicine (ABFM) Practice Exam

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In asymptomatic aortic stenosis, what is the recommended next step in management?

  1. Exercise treadmill testing

  2. Right heart catheterization

  3. Repeat echocardiography in 3-5 years

  4. Cardiothoracic surgery consultation

The correct answer is: Repeat echocardiography in 3-5 years

In cases of asymptomatic aortic stenosis, the recommended next step in management is to perform a repeat echocardiography in 3-5 years. This approach is based on the understanding that asymptomatic patients with mild to moderate aortic stenosis often do not require immediate intervention. Regular monitoring with echocardiography allows for the assessment of the progression of the disease. Echocardiography is a key non-invasive tool that provides information about the severity of the stenosis, hemodynamic status, and left ventricular function. In cases where the degree of stenosis remains stable and the patient does not progress to symptoms, repeating the echocardiogram after a few years is sufficient. If significant changes are noted or if the patient becomes symptomatic, further intervention may be warranted, including potential surgical options. In contrast, exercise treadmill testing is generally not indicated for asymptomatic aortic stenosis, as it could potentially provoke symptoms or carry risks in this patient population. Right heart catheterization is typically reserved for evaluating the hemodynamics in patients who already exhibit symptoms or for conditions where precise measurements are needed, rather than for asymptomatic patients. Consulting a cardiothoracic surgeon for a surgical evaluation is usually considered when patients become symptomatic or if