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Postoperative pulmonary embolism — USMLE Step 3 MCQ

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HardSurgeryPostoperative pulmonary embolismUSMLE Step 3

A 58-year-old receiving appropriate antibiotics for mitral-valve infective endocarditis develops acute severe mitral regurgitation and pulmonary edema. MRI obtained for transient hand weakness shows a small ischemic embolic infarct without hemorrhage or extensive neurologic injury. Which management is most appropriate?

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Correct answer: B — Pursue early mitral-valve surgery during the current hospitalization

The best answer is “Pursue early mitral-valve surgery during the current hospitalization”. Acute severe regurgitation with heart failure is a major indication for early surgery in infective endocarditis. A small ischemic stroke without hemorrhage or extensive injury does not require the delay used after intracranial hemorrhage. Antibiotics continue, but they do not correct destructive valve failure. The alternatives are less suitable because they mistime the intervention, omit a necessary component, or apply treatment for a different physiologic problem; the stem's decisive findings determine the sequence.

Reference: ACC/AHA, Surgical Treatment of Infective Endocarditis: https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2022/05/09/19/39/current-recommendations-and-uncertainties