American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a key indicator for surgical intervention in valve infection complications?

1. High-grade fever alone

2. Valvular dysfunction leading to heart failure

3. Minor regurgitation symptoms

4. Age greater than 70

The correct answer is: Valvular dysfunction leading to heart failure

Valvular dysfunction leading to heart failure is a key indicator for surgical intervention in cases of valve infection complications, particularly endocarditis. When an infective endocarditis leads to significant valvular dysfunction, it can compromise the hemodynamics of the heart, resulting in heart failure. Signs of heart failure may include fatigue, shortness of breath, and fluid retention, which indicate that the heart is not able to effectively pump blood due to impaired valve function. In situations where the valvular damage is acute or the patient exhibits new or worsening heart failure symptoms, timely surgical intervention can be crucial to prevent further complications, such as severe heart failure or systemic embolization. The presence of valvular dysfunction reflects a state that is critical enough to warrant surgical evaluation and, often, surgical repair or replacement of the affected valve. Other factors such as high-grade fever may be present in infections, but they do not specifically indicate the deterioration of cardiac function that warrants surgery. Minor regurgitation symptoms are often managed medically unless they are associated with significant hemodynamic compromise. Age greater than 70 can be a consideration in weighing surgical risks but is not an independent indicator for surgical intervention. Therefore, the presence of valvular dysfunction leading to heart