Where do you Auscultate for papillary muscle dysfunction! - USMLE Forums
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  #1  
Old 09-04-2011
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Stethoscope Where do you Auscultate for papillary muscle dysfunction!

A patient suffers a myocardial infarction which results in papillary muscle dysfunction. This patient will most likely have a murmur that is best auscultated at the:
A. Second intercostal space, right upper sternal border
B. Fifth intercostal space, lateral to left midclavicular line
C. Fourth intercostal space, lower left sternal border
D. Fifth intercostal space, lateral to right midclavicular line
E. Second intercostal space, left upper sternal border
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  #2  
Old 09-04-2011
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E. Second intercostal space, left upper sternal border
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  #3  
Old 09-04-2011
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Mitral Regurgitation = apex, with radiation into the axilla
B. Fifth intercostal space, lateral to left midclavicular line
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  #4  
Old 09-04-2011
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Mitral regurgitation => Holosystolic murmur best heard at apex and radiating to axilla

So answer is B

In case of papillary muscle dysfunction there is mild MR so the murmur is late systolic.

This may eventually lead to MVP which may lead to ejection systolic murmur at the base of heart.
so option E is correct in late stages.
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Old 09-05-2011
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yes its definitely B!.. Mitral regurg!
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Old 09-05-2011
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its mitral regurgitation, usually secondary to inferior infarcts , that is that of the RCA, best heard at the apex moving into the axilla....

it is also a pansystolic murmur.
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Old 09-05-2011
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mitral regurg. b
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Old 09-06-2011
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If MI is producing papillary muscle dysfunction,why it is causing mitral valve regurg but no mitral valve prolapse??

And I think both the murmur of mitral regurg and mitral valve prolapse are best heard at apex ??
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Old 09-06-2011
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B. Fifth intercostal space, lateral to left midclavicular line

Mitral Valve Prolapse...
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Old 09-06-2011
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Answer should be B, Mitral Valve Prolapse.. due Papillary muscle dysfunction.
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Old 09-08-2011
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The correct answer is B.
Papillary muscle dysfunction can occur secondary to a myocardial infarction. This dysfunction results in mitral valve regurgitation, which is best auscultated at the fifth intercostal space, lateral to left midclavicular line.
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  #12  
Old 09-08-2011
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Simple question .. Yet I guessed D from the beginning because I did not read the word "Right" ... These forms of questions (D and B) are annoying me in tests since you pick up the answer too quickly wrong .. Which is of course B (Mitral regurgitation)
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  #13  
Old 09-08-2011
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Left fifth intercostal space lateral to left midclavicular line.
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Old 09-08-2011
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B) 100%
Mitral Insuficiency
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Old 09-08-2011
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Answer (B)
Paillary muscle dysfunction usually results from ischemia of the LV and results in Acute Mitral regurgitation, best osculated at the cardiac apex (Left 5th intercostal space at or slightly left to the mid-clavicular line)
Another example of that is the patient who has MI causing papillary muscle rupture leading to flail metal leaflets and acute life threatening MR
The best way to be able to diagnose both by auscultation is to document the basic cardiac examination on admission and then follow up examination for any auscultatory change
The 2nd intercostal space is called the aortic area on the left where the AS is best auscultated, and is called pulmonary area on the right where the pulmonary valve can be auscultated in situations like PS, PR, Pulmonary. HTN.
The 5th intercostal space at the right midclavucular line is out of the cardiac auscultation scope
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