Question of the Week
For February 21, 2017
A 67-year-old man with type 2 diabetes reports new-onset mild dyspnea on exertion during the past several months. He has rheumatoid arthritis and moderate mitral regurgitation, for which he has been followed with a yearly echocardiogram. His only medications are aspirin, simvastatin, and hydroxychloroquine.
On examination, the patient has normal vital signs, normal jugular venous pressure, clear lungs, a grade 3/6 holosystolic murmur at the apex that radiates to the axilla, and trace lower-extremity edema. His electrocardiogram shows normal sinus rhythm at 70 beats per minute, with nonspecific ST-segment and T-wave abnormalities.
A transthoracic echocardiogram reveals severe mitral regurgitation, which has worsened since the previous study. There is bileaflet mitral valve prolapse and a new flail posterior leaflet segment. The left ventricular ejection fraction is 60%. Given the patient’s symptoms and echocardiographic findings, he is referred for mitral valve repair.
Which one of the following preoperative tests is indicated for this patient?