A 58-year-old man on ICU develops acute pulmonary oedema after rapid IV fluid bolus. Echocardiography shows severe mitral stenosis (MVA 0.8 cm²) with ...

Question

A 58-year-old man on ICU develops acute pulmonary oedema after rapid IV fluid bolus. Echocardiography shows severe mitral stenosis (MVA 0.8 cm²) with a dilated left atrium. He is in atrial fibrillation with rapid ventricular response (HR 150 bpm). What is the most important immediate haemodynamic intervention?

Accepted Answer

Rate control to slow the heart rate, allowing adequate diastolic filling time across the stenotic mitral valve

Answer

IV dobutamine to improve cardiac output

Answer

IV GTN to reduce preload

Answer

IV frusemide 80 mg and observe

Answer

Emergency mitral valve replacement

uk-fficm MCQ (SBA): Mitral Stenosis with AF