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  #1  
Old 08-01-2011
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Star Cardiovascular physiology - tricky question!

A 50 y/o woman is admitted to the clinic for an elective cardiac catheterization because of a 9 month history of worsening fatigue and shortness of breath. The results of the cardiac catheterization are shown:

Pulmonary artery pressure 45/25 mm Hg
Pulmonary wedge pressure 30 mm Hg
Left ventricular pressure 120/5 mm Hg
Aortic pressure 120/80 mm Hg

Which of the following is the most likely diagnosis?

A) Aortic Regurgitation
B) Aortic Stenosis
C) Mitral Regurgitation
D) Mitral Stenosis
E) Hypertrophic cardiomyopathy
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  #2  
Old 08-01-2011
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Mitral regurgitation, this explains why LVEDP is low, pulmonary artery diastolic pressure and pulmonary wedge pressure are high.

Blood regurgitate to LA during diastole causing decrease in LVEDP and increase in pulmonary artery diastolic pressure and pulmonary wedge pressure
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  #3  
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Mitral stenosis
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Old 08-01-2011
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Quote:
Originally Posted by bebix View Post
A 50 y/o woman is admitted to the clinic for an elective cardiac catheterization because of a 9 month history of worsening fatigue and shortness of breath. The results of the cardiac catheterization are shown:

Pulmonary artery pressure 45/25 mm Hg
Pulmonary wedge pressure 30 mm Hg
Left ventricular pressure 120/5 mm Hg
Aortic pressure 120/80 mm Hg

Which of the following is the most likely diagnosis?

A) Aortic Regurgitation
B) Aortic Stenosis
C) Mitral Regurgitation
D) Mitral Stenosis
E) Hypertrophic cardiomyopathy
THE ANS is mitral stenosis
there is increased pressure in the left atrium due to stenosis pulmoary capillary wedge pressure is an index of left atrial pressure with normal value of 12mmhg
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Old 08-01-2011
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D. mitral stenosis. increase pul and wedge

mitral regurg- increase pul, wedge, left vent

aortic regurg- increase pul, wedge, left vent, aortic

aortic stenosis- increase pul, wedge, left vent
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Old 08-01-2011
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mitral stenosis
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Old 08-01-2011
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I saw similar one in UW - answer is d) mitral stenosis;Increased left atrial pressure increases pressure in small (pulmonary) circle of circulation.
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Answer is Mitral Stenosis, There is an Increase of LA pressure, >12.
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could be MS and hyperthrophy cardioMYOPATHY TOO. but 50 y o and 9 month symptoms. more probable MS. what's the tricky about this?
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Quote:
Originally Posted by dr_lizard View Post
could be MS and hyperthrophy cardioMYOPATHY TOO. but 50 y o and 9 month symptoms. more probable MS. what's the tricky about this?
hyperthrophy cardiomyopathy and MS has completely different cardiac catheterization results

and btw, why not C) Mitral Regurgitation???...hahaha
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Quote:
Originally Posted by bebix View Post
hyperthrophy cardiomyopathy and MS has completely different cardiac catheterization results
ops! i just was thinking of that hypertrophy makes mitral stenosis too. so what;s diferences?
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Quote:
Originally Posted by bebix View Post
and btw, why not C) Mitral Regurgitation???...hahaha
Mitral regurgitation wouldn't happen. The pressure is too high behind the mitral valve (left atrium and pulmonary artery) to allow it.
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Quote:
Originally Posted by dr_lizard View Post
ops! i just was thinking of that hypertrophy makes mitral stenosis too. so what;s diferences?
Hypertrophic cardiomyopathy:

About 25% of individuals with HCM demonstrate an obstruction to the outflow of blood from the left ventricle during rest. In other individuals obstruction only occurs under certain conditions. This is known as dynamic outflow obstruction, because the degree of obstruction is variable and is dependent on the amount of blood in the ventricle immediately before ventricle systole (contraction).

Dynamic outflow obstruction (when present in HCM) is usually due to systolic anterior motion (SAM) of the anterior leaflet of the mitral valve.
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yes, i meant obstruction!!! but would be the same pressure result as MS,
also if pcwp>lv diatolic pressure then it s MS not regurgitation
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Originally Posted by dr_lizard View Post
yes, i meant obstruction!!! but would be the same pressure result as MS,
also if pcwp>lv diatolic pressure then it s MS not regurgitation
Actually, Hypertrophic cardiomyopathy is more like an AS with MI (due to the SAM)

btw, the correct answer is Mitral Stenosis
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Quote:
Originally Posted by bebix View Post
Actually, Hypertrophic cardiomyopathy is more like an AS with MI (due to the SAM)

btw, the correct answer is Mitral Stenosis
ok, tnx
so u trick us by tricky title! it was double trick!
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D) Mitral Stenosis
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