Test your medicine knowledge: 62-year-old man is evaluated during a routine visit
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 62-year-old man is evaluated during a routine visit. He is asymptomatic and walks 1 mile most days of the week. Medical history is significant for aortic stenosis, type 2 diabetes mellitus, hypertension, and hyperlipidemia. Medications are aspirin, metformin, lisinopril, metoprolol, and rosuvastatin.
On physical examination, the patient is afebrile, blood pressure is 130/66 mm Hg, pulse rate is 68/min, and respiration rate is 14/min. BMI is 29. Cardiac examination reveals a grade 2/6 early-peaking systolic murmur at the cardiac base. Carotid upstrokes are normal. The remainder of the examination is unremarkable.
Laboratory studies demonstrate a total serum cholesterol level of 150 mg/dL (3.89 mmol/L). Electrocardiogram is within normal limits. Echocardiogram from 1 year ago shows a peak velocity of 2.0 m/s, mean transaortic gradient of 13 mm Hg, aortic valve area of 1.5 cm2, and preserved ejection fraction.
Which of the following is the most appropriate management?
A: Echocardiogram
B: Exercise perfusion study
C: Exercise stress test
D: No additional testing
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Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: mksap Tags: Conditions Heart Source Type: blogs
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