American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following is NOT a key indication for mitral valve replacement?

1. Atrial fibrillation

2. Symptoms

3. History of myocardial infarction

4. Severe mitral regurgitation

The correct answer is: History of myocardial infarction

Mitral valve replacement is primarily indicated in cases of severe mitral valve disease, such as severe mitral regurgitation or stenosis, particularly when patients are symptomatic or there is evidence of left ventricular dysfunction. Atrial fibrillation is a common arrhythmia associated with mitral valve disease and can be an indication for mitral valve replacement, specifically if it contributes to symptoms or affects hemodynamics. Symptoms such as dyspnea, fatigue, or decreased exercise tolerance are central to the decision-making process; if a patient experiences significant symptoms due to their mitral valve condition, this would warrant surgery. Severe mitral regurgitation is a well-established indication for surgery, particularly when patients exhibit symptoms or there are signs of declining cardiac function. History of myocardial infarction, while significant in evaluating overall cardiac health, is not a direct indication for mitral valve replacement unless there are accompanying issues with the mitral valve itself or the overall cardiac function is severely compromised due to consequences of ischemic heart disease. Thus, this option reflects a condition that may influence management but is not a standalone key indication for mitral valve replacement.