Regurgitant valvular heart disease that is severe is an absolute contraindication to exercise. Which option describes this?

• A. Mild regurgitation requiring no surgery.
• B. Moderate regurgitation with no symptoms.
• C. Severe regurgitation controlled with meds.
• D. Valve disease severe enough to need surgical repair.

Answer: (D)

Severe regurgitant valve disease becomes an absolute contraindication to exercise because the heart already has to handle a large backward flow each beat, creating a significant volume overload. During exercise, heart rate and contractility rise, which worsens the regurgitation, increases end-diastolic and left atrial pressures, and can lead to pulmonary congestion or heart failure. When the severity is such that surgical repair or replacement is required, the safest approach is definitive treatment rather than continuing exercise. The other scenarios describe milder forms or disease controlled without surgery, where exercise may be considered with appropriate medical guidance, but they do not meet the threshold of an absolute contraindication.