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Aortic Stenosis — RACP Adult Medicine MCQ

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ModerateCardiologyAortic StenosisRACP Adult Medicine

A 50-year-old man presents with syncope during exertion. Examination reveals a harsh ejection systolic murmur radiating to the carotids with a slow-rising pulse. Echocardiography shows a heavily calcified aortic valve with a mean gradient of 52 mmHg, peak velocity 4.5 m/s, and valve area 0.8 cm². LVEF is 60%. What is the most appropriate management?

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Correct answer: B — Aortic valve replacement (surgical or TAVI)

This patient has severe symptomatic aortic stenosis (valve area <1.0 cm², mean gradient >40 mmHg, peak velocity >4 m/s) with syncope on exertion. Untreated symptomatic severe AS carries a very poor prognosis (2-year mortality ~50%). Aortic valve replacement (surgical AVR or TAVI depending on age and risk profile) is strongly indicated. Medical therapy alone does not improve survival.

Reference: eTG – 2025 – Cardiovascular; CSANZ – 2022 – Valvular Heart Disease Guidelines