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Severe aortic stenosis before surgery — MCCQE Part 1 MCQ

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HardPre-operative AssessmentSevere aortic stenosis before surgeryMCCQE Part 1

A 67-year-old man is assessed before elective colectomy. He has exertional chest discomfort after walking one block and a loud systolic murmur radiating to the neck. ECG shows left ventricular hypertrophy. What is the most appropriate investigation?

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Correct answer: E — Transthoracic echocardiography before surgery

Symptoms suggestive of severe aortic stenosis require echocardiography before elective non-cardiac surgery to define perioperative risk. Proceeding without assessment risks perioperative haemodynamic collapse. Troponin surveillance is postoperative risk monitoring, not preoperative diagnosis. Carotid Doppler and CT pulmonary angiography do not assess the suspected valve lesion.

Reference: Canadian Cardiovascular Society perioperative cardiac risk guidance