Objectives:

• Recognize symptoms of aortic stenosis
• Manage a patient with aortic stenosis
• Evaluate aortic and mitral valve disease and determine long-term follow-up vis-à-vis periodic echocardiograms

1		A 75-year-old male presents to your office for a complete physical. On exam, you notice a 3/6 systolic ejection murmur radiating to the neck. He has never before been told that he has a murmur. You send the patient for an echocardiogram, and the report notes mild aortic stenosis. Currently he is asymptomatic. The indications for valve replacement surgery in this patient include:
			A)	Grade 4/6 murmur.
			B)	Requirement for major, semi-elective surgery such as prostatectomy.
			C)	Evidence of left ventricular dysfunction.
			D)	None of the above.
2		The patient would like to know how often he should have a repeat echocardiogram given that he has mild disease. Your answer is:
			A)	Every 3–5 years.
			B)	Every year.
			C)	Every 6 months.
			D)	When he develops symptoms.
			E)	None of the above.
3		Two years later, the patient returns for a checkup and states that he believes he has been having symptoms from his aortic stenosis. All of the following can occur with symptomatic aortic stenosis EXCEPT:
			A)	Left-to-right intracardiac shunt.
			B)	Exertional dyspnea.
			C)	Syncope.
			D)	Angina.
			E)	All of the above.
4		Which of the following statements is correct about the treatment of valvular heart disease?
			A)	Aortic stenosis can be treated quite effectively with valvulotomy.
			B)	Mitral stenosis should be treated with open valve replacement.
			C)	Patients with aortic stenosis have the same life expectancy as the general public once the valve is replaced.
			D)	Patients with isolated, asymptomatic, mitral valve prolapse require endocarditis prophylaxis.
			E)	All of the above are correct.