American Board of Internal Medicine (ABIM) Certification Practice Exam

What triggers the need for transthoracic echocardiography in valvular heart disease?

1. Regular monitoring

2. No change in clinical symptoms

3. Change in clinical symptoms

4. Patient's age

The correct answer is: Change in clinical symptoms

Transthoracic echocardiography is primarily indicated when there is a change in clinical symptoms in patients with valvular heart disease. The presence of new or worsening symptoms, such as dyspnea, fatigue, or chest pain, can imply that the valvular condition may be progressing or causing hemodynamic changes. This shift in clinical status prompts a reassessment of the valvular function, the degree of regurgitation or stenosis, and any impact on cardiac structure and function. Detecting these changes is crucial for determining the need for potential interventions, such as surgical repair or replacement of a valve. Regular monitoring is typically performed during stable periods but is not the immediate trigger for further echocardiographic assessment unless there is an accompanying change in the patient’s symptomatology. Consequently, while factors such as a patient’s age and stable symptoms may influence overall management, the most pressing need for echocardiography arises from newly developed or altered clinical symptoms.