From 59e2b0de6850a6e6be9f43cba50dd0321c03c7c2 Mon Sep 17 00:00:00 2001
From: Gerrit Cloete <gerrit@toposoftware.co.za>
Date: Fri, 10 Jan 2025 13:54:43 +0200
Subject: [PATCH] Add: new aortic stenosis management question for cardiology

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 .../cardiology/valvular/aorticStenosis.md     | 75 +++++++++++++++++++
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 create mode 100644 questions/cardiology/valvular/aorticStenosis.md

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+---
+id: CARD014
+specialty: cardiology
+topic: valvular_disease
+difficulty: medium
+tags: [cardiovascular, valvular, aortic_stenosis, surgery]
+created: 2025-01-10
+lastUpdated: 2025-01-10
+---
+
+# Aortic Stenosis Management
+
+## Question
+A 75-year-old man presents with progressive dyspnea and chest pain on moderate exertion. Echo shows:
+
+- Aortic valve area: 0.8 cm²
+- Mean gradient: 45 mmHg
+- Peak velocity: 4.2 m/s
+- LVEF: 55%
+
+Current Status:
+- NYHA Class II-III symptoms
+- Independent in daily activities
+- No significant comorbidities
+
+Vital Signs:
+- BP: 132/82 mmHg
+- HR: 78/min
+- RR: 16/min
+- SpO2: 97% on room air
+- Temperature: 36.7°C (98.1°F)
+
+Which management strategy is most appropriate?
+
+## Options
+| Option | Description |
+|--------|-------------|
+| A)     | Medical management with beta-blocker and follow-up echo in 6 months |
+| B)     | Referral for surgical AVR evaluation |
+| C)     | Balloon aortic valvuloplasty |
+| D)     | Referral for TAVR evaluation |
+| E)     | Exercise stress test to confirm symptoms |
+
+<details>
+<summary>View Answer</summary>
+
+## Correct Answer
+B
+
+## Explanation
+This case presents severe symptomatic aortic stenosis in a relatively healthy elderly patient:
+
+1. Key Diagnostic Findings:
+   - Severe AS (valve area <1.0 cm², mean gradient >40 mmHg)
+   - Symptoms correlating with AS
+   - Preserved LV function
+   - No major contraindications
+
+2. Why Option B is optimal:
+   - Surgical AVR is first-line for healthy elderly
+   - Good surgical candidate (few comorbidities)
+   - Class I indication per guidelines
+   - Better long-term outcomes
+
+3. Why other options fail:
+   - A) Medical therapy insufficient for severe symptomatic AS
+   - C) Valvuloplasty only temporary bridge
+   - D) TAVR second-line for lower-risk patients
+   - E) Symptoms already clear, testing unnecessary
+
+## References
+- ACC/AHA 2021: "Valvular Heart Disease Guidelines"
+- JACC 2022: "Management of Severe Aortic Stenosis"
+- ESC 2022: "Valvular Heart Disease Management"
+</details>