American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a class I indication for intervention in mitral regurgitation?

1. Asymptomatic patients

2. Symptoms present

3. Severe mitral regurgitation

4. Progressive decrease in ejection fraction

The correct answer is: Symptoms present

In the context of mitral regurgitation, a class I indication for intervention is when symptoms are present. This classification is based on the guidelines that prioritize operations on patients who exhibit symptoms, as the risks often outweigh the benefits if left untreated. When patients are symptomatic, it indicates that the mitral regurgitation is significantly impacting their quality of life or may lead to further complications such as heart failure. These symptoms may include exertional dyspnea, fatigue, or palpitations, which suggest that the heart is struggling to maintain adequate circulation due to regurgitant flow. Appropriate interventions, such as surgical repair or replacement of the mitral valve, can significantly improve outcomes and alleviate symptoms. In contrast, asymptomatic patients or those with severe mitral regurgitation but no symptoms might not meet the criteria for immediate intervention, as the risks of surgery can outweigh the potential benefits. Additionally, a progressive decrease in ejection fraction is a cautious indicator that may warrant close monitoring, but it alone does not constitute a class I indication without the presence of symptoms.