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Acute severe aortic regurgitation — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsAcute severe aortic regurgitationSCE Acute Medicine

A 82-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 flail aortic cusp, pulmonary oedema and suspected endocarditis. What is the most appropriate next step in management?

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Correct answer: D — Arrange urgent cardiothoracic referral with intravenous antibiotics

The key discriminator is that flail aortic cusp, pulmonary oedema and suspected endocarditis, which makes Arrange urgent cardiothoracic referral with intravenous antibiotics the single best answer. Arrange routine outpatient follow-up is less appropriate because it does not address the dominant acute risk in the vignette; Optimise chronic medication and discharge would fit a different presentation or later stage of care. Arrange urgent specialist referral and Give intravenous fluids with reassessment 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 guideline