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Acute severe mitral regurgitation — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsAcute severe mitral regurgitationSCE Acute Medicine

A 69-year-old woman presents with acute chest symptoms with haemodynamic concern. Relevant history includes cardiovascular risk factors or structural heart disease. On assessment, haemodynamic findings and ECG changes are present. Investigations show new pansystolic murmur and pulmonary oedema after inferior MI. What is the most appropriate next step in management?

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Correct answer: A — Refer urgently to cardiothoracic and critical care teams

The key discriminator is that new pansystolic murmur and pulmonary oedema after inferior MI, which makes Refer urgently to cardiothoracic and critical care teams the single best answer. Start broad-spectrum intravenous antibiotics is less appropriate because it does not address the dominant acute risk in the vignette; Provide supportive care and close monitoring would fit a different presentation or later stage of care. Give controlled oxygen and senior review and Give targeted antidote or reversal therapy are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: ESC valvular heart disease guideline