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Cardiac AL Amyloidosis — RACP Adult Medicine MCQ

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HardCardiologyCardiac AL AmyloidosisRACP Adult Medicine

A 76-year-old has a calcified aortic valve, LVEF 32%, stroke volume index 30 mL/m², valve area 0.8 cm² and mean gradient 28 mmHg. Symptoms are exertional. Which test best distinguishes truly severe from pseudo-severe low-flow aortic stenosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Perform low-dose dobutamine stress echocardiography with flow assessment

Explanation lettering: E = shown as B · B = shown as D · D = shown as E

C is correct. In classical low-flow, low-gradient AS with reduced LVEF, low-dose dobutamine assesses flow reserve and whether valve area remains severe as flow increases. D does not provide validated classification. E is unsafe in this symptomatic phenotype. A coronary calcium is not valve calcium quantification. B does not resolve the flow-dependence of valve measurements.

Reference: CSANZ, Structural and valvular heart disease echocardiography position statement 2024: https://www.csanz.edu.au/Common/Uploaded%20files/Smart%20Suite/Smart%20Library/4da25b2b-e4c7-41a9-ac2f-ec941ad5a681/2024%20CSANZ%20Position%20Statement%20on%20Indications%2C%20Assessment%20and%20Monitoring%20of%20Structural%20and%20Valvular%20Heart%20Disease%20With%20Transthoracic%20Echocardiography%20in%20Adults%282024%29.pdf