American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with a bicuspid aortic valve, when is an aortic diameter greater than 4.5 cm concerning?

1. Only if symptomatic

2. Always concerning

3. When it is accompanied by hypertension

4. When associated with palpitations

The correct answer is: Always concerning

In patients with a bicuspid aortic valve, an aortic diameter greater than 4.5 cm is always concerning due to the risk of aortic dilation and potential dissection or rupture. The presence of a bicuspid aortic valve itself predisposes individuals to an accelerated aortic dilation process, making it crucial to monitor the size of the aorta carefully. The threshold of 4.5 cm is clinically significant as it is the point where the risk of adverse events increases substantially, warranting closer investigation and often intervention, regardless of the presence or absence of symptoms. While hypertension and symptoms such as palpitations can contribute to overall cardiovascular risk, they are not necessary prerequisites for assessing the significance of aortic diameter in this context. The primary concern lies with the mere measurement of the aortic diameter in conjunction with the anatomical anomaly of the bicuspid valve, underscoring the importance of regular imaging to monitor for changes over time. This proactive approach is vital to prevent possible life-threatening complications associated with aortic pathology.