American Board of Internal Medicine (ABIM) Certification Practice Exam

For very severe aortic stenosis, with a Vmax of 5 m/s or greater, how often should evaluations occur?

1. Every month

2. Clinical eval every 6-12 months; echo every yearly

3. Clinical eval yearly; echo every 6-12 months

4. Clinical eval yearly; echo every 1-2 years

The correct answer is: Clinical eval yearly; echo every 6-12 months

In cases of very severe aortic stenosis characterized by a peak jet velocity (Vmax) of 5 m/s or greater, regular monitoring is vital due to the associated risk of symptom development and complications, including heart failure and sudden cardiac death. Clinical evaluation every year is recommended to assess for the emergence of symptoms such as dyspnea, angina, or syncope, which signal disease progression and may necessitate more urgent intervention. In addition, performing echocardiograms every 6-12 months allows for close observation of the hemodynamic severity and structural changes of the heart over time, particularly the left ventricle, providing critical information on whether surgical intervention, such as aortic valve replacement, might be needed. By adhering to this schedule of evaluations, healthcare providers can effectively track the patient's condition and make timely clinical decisions to optimize patient outcomes. This structured approach to monitoring aligns with current clinical guidelines that prioritize proactive management in very severe cases of aortic stenosis.