American Board of Internal Medicine (ABIM) Certification Practice Exam

What indicates the need for mitral valve replacement in cases of mitral regurgitation?

1. Symptoms

2. Pulmonary hypertension

3. Left ventricular hypertrophy

4. Stable blood pressure

The correct answer is: Symptoms

The need for mitral valve replacement in cases of mitral regurgitation is primarily indicated by the presence of symptoms. Symptoms such as dyspnea on exertion, fatigue, and reduced exercise tolerance often signal the progression of the disease and the impact of the abnormal blood flow on the function of the heart and the patient's quality of life. In asymptomatic patients, the decision for surgical intervention is typically based on objective measures such as left ventricular size and function, rather than solely on the presence of pulmonary hypertension or left ventricular hypertrophy. Symptoms are critical because they reflect how the patient is coping with the condition and provide insight into the severity of the regurgitation and the consequences on cardiac output and performance. The presence of pulmonary hypertension can certainly be a factor that complicates mitral regurgitation but is not an independent indicator for surgery. Left ventricular hypertrophy is also a sign of increased workload imposed by the regurgitation, but like pulmonary hypertension, it does not alone necessitate surgical intervention unless accompanied by symptoms. Stable blood pressure, while important for overall cardiac function, does not impact the urgency or need for surgical correction in mitral regurgitation. Hence, the presence of symptoms remains the most critical determinant for deciding on mitral