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  #1  
Old 08-05-2011
qurat21's Avatar
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Default CVS

63yr old man presents to ER with severe dyspnea orthopnea n fatigue.he suffered from MI six months ago,n has not been compliant with his medication since then.on examination B.P.170/100mmhg,HR 100/min,crackles at lung bases, S3 gallop n holosystolic murmur over apex. after initial treatment with diuretics n vasodilators condition improves significantly.next morning there re no appreciable murmurs or gallop on cardiac examination.the murmur heard at the time of presentation is most likely due to

a.thickened n deformed mitral valve
b.heavily calcified mitral annulus
c,increased flow rate through aortic valve
d.ruptured chorda tendineae
e.functional mitral regurgitaion

pls ans with explanation n if u knw of any other related condition plss mention i must say the q is frm U WORLD the aim is to open a discussion n know more such situations .
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Old 08-05-2011
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C.increased flow rate thru aortic valve
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  #3  
Old 08-05-2011
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Default Functional mitral regurgitation

Answer is E, functional mitral regurgitation.

The patient in this question is not compliant with his medication after suffering a myocardial infarction. MI patients suffer from reduced ejection fraction, which if untreated will precipitate congestive heart failure. The S3 gallop is indicative of volume overload in the patient's failing heart. An overloaded ventricle dilates, leading to dilation of the mitral annulus. The leaflets of the mitral valve therefore won't overlap, leading to functional mitral regurgitation because of the dilated annulus. A holosystolic murmur is characteristic of mitral regurgitation.

Treating this patient will involve the use of diuretics to reduce preload on the failing heart, along other medication such as beta blockers and possibly ACE inhibitors. This will eventually bring the ventricle back to its original size, and the mitral annulus to its original conformation. S3 gallop and the functional mitral regurgitation murmur will disppear.
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Old 08-05-2011
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Quote:
Originally Posted by qurat21 View Post
63yr old man presents to ER with severe dyspnea orthopnea n fatigue.he suffered from MI six months ago,n has not been compliant with his medication since then.on examination B.P.170/100mmhg,HR 100/min,crackles at lung bases, S3 gallop n holosystolic murmur over apex. after initial treatment with diuretics n vasodilators condition improves significantly.next morning there re no appreciable murmurs or gallop on cardiac examination.the murmur heard at the time of presentation is most likely due to

a.thickened n deformed mitral valve
b.heavily calcified mitral annulus
c,increased flow rate through aortic valve
d.ruptured chorda tendineae
e.functional mitral regurgitaion

pls ans with explanation n if u knw of any other related condition plss mention i must say the q is frm U WORLD the aim is to open a discussion n know more such situations .
.functional mitral regurgitaion
try and identify the condition first...as there is S3 and a holosyst murmur at the apex, most likely a MR,
and a vasodilator would decrease the after load on the heart...therefore increasing the forward to backward ratio...more blood in forward direction, decrease intensity of the murmur...hope it helps...
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Old 08-05-2011
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Ans: e) functional mitral regurgitaion - S3 gallop is specific for mitral problem;


My logic - All other options a;b;d = is structural and should not change clinical presentation after treatment,


also c) Increased flow through aortic valve can't happen with dyspnea;orthopnea;fatigue (CHF symptoms)
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Old 08-05-2011
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Hey qurat21, if you are finding difficulties with CVS, particularly murmors and stuff, I highly recommend Goljan audios! I was just like you, I struggled with them.. But after listening to them a few times, it becomes super easy!
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