Valvular Heart Disease Practice Test

A 55-year-old woman reports fatigue and palpitations. Exam: holosystolic murmur at apex radiating to axilla, S3 present, bibasilar crackles. ECG shows atrial fibrillation. Doppler echo: severe MR with enlarged LA, LVEF 65%. Which is the most appropriate initial treatment?

A 45-year-old man with prior endocarditis now has severe AR. Exam: early diastolic murmur at LSB and wide pulse pressure. Echo shows regurgitant jet and LV dilation. Which diagnostic test best confirms severity and guides timing of surgery?