This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Valvular hea diseases, Subject name: Medicine
[{'content': 'A person with aoic stenosis could perform exercise for 11 minutes in Bruce protocol. Exercise had to be stopped due to fatigue. He had a peak systolic gradient of 60 mm Hg across the aoic valve at rest. The best management for him would be? \nSelect and explain. \nA. Medical management, B. Aoic valve balloon dilation to prevent worsening, C. Aoic valve replacement, D. Coronary angiography', 'role': 'user'}, {'content': 'Answer: C \nExplanation: Diagnosis: Severe AS as trans-valvular peak gradient of 60 mmHg. Since patient managed to perform on the Treadmill for up to stage 3 (beyond 9 minutes) of Bruce protocol without any ECG changes - ASYMPTOMATIC SEVERE AOIC STENOSIS. In Modified Bruce protocol there are 7 stages of 3 minutes each on a treadmill, for which the patient walks on the treadmill at a gradually increasing speed.. There is a change in guidelines with surgery being indicated for asymptomatic severe AS due to progressive nature of disease. Indications for Aoic valve replacement: An abnormal response to treadmill exercise. Rapid progression of AS, especially when urgent access to medical care might be compromised Very severe AS defined by a valve area <0.6 cm2. Severe LVH suggested by a wall thickness of >15 mm.', 'role': 'assistant'}]