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Old 10-10-2012
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Arrow Billy Step 1 Questions # 23

A 44-year-old, previously healthy man has experienced worsening exercise tolerance accompanied by marked
shortness of breath for the past 6 months. On physical examination, he is afebrile. His pulse is 78/min, respirations are
22/min, and blood pressure is 110/70 mm Hg. He has diffuse rales in all lung fields and pitting edema to the knees.
Laboratory studies show serum sodium, 130 mmol/L; potassium, 4 mmol/L; chloride, 102 mmol/L; CO2, 25 mmol/L;
creatinine, 2 mg/dL; and glucose, 120 mg/dL. A 100-mL urine sample is collected. There is 1.3 mmol of sodium and 40 mg
of creatinine in the urine sample. A chest radiograph shows cardiomegaly and pulmonary edema with pleural effusions. An echocardiogram shows four-chamber cardiac dilation and mitral and tricuspid valvular regurgitation, with an ejection
fraction of 30%. A coronary angiogram shows less than 10% narrowing of the major coronary arteries. Which of the
following is the most likely diagnosis?


□ (A) Rheumatic heart disease
□ (B) Hereditary hemochromatosis
□ (C) Chagas disease
□ (D) Diabetes mellitus
□ (E) Idiopathic dilated cardiomyopathy
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idiopathic dilated cardiomyopathy
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E) idiopathic dilated cardiomyopathy????
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Old 10-10-2012
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My answer E)
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Default my answer :)

(E) Idiopathic dilated cardiomyopathy
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E. idiopathic dilated cardiomyopathy


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Old 10-10-2012
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Correct Answer E is correct

Congestive heart failure with four-chamber dilation is suggestive of dilated cardiomyopathy; implicated in causation
are myocarditis, alcohol abuse, and genetic factors (in 20% to 50% of cases). The patient's fractional excretion of sodium
is less than 1%, consistent with prerenal azotemia. Many cases of dilated cardiomyopathy have no known cause. Dilation
is more prominent than hypertrophy, although both are present, and all chambers are involved. Rheumatic heart disease
would most often produce some degree of valvular stenosis, often with some regurgitation, and the course usually is more
prolonged. Hemochromatosis produces restrictive cardiomyopathy. Chagas disease affects the right ventricle more often
than the left. Coronary artery narrowing would be worse in diabetes mellitus and accelerated atherosclerosis
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