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  #1  
Old 04-29-2013
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Stethoscope Murmur in Pregnancy!

A 39 year old woman at 30 weeks gestation has a systolic murmer at the left lower sternal border and splitting of S2 that are both pronounced during inspiration. The remainder of the physical examination is unremarkable. Which of the following is the best explanation for these findings?

A) Aortic stenosis
B) Constrictive pericardial disease
C) Hypertrophic cardiomyopathy
D) Mitral insufficiency
E) Mitral Stenosis
F) NOrmal physiological response

Can anyone help me explain the answer plz thanks
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  #2  
Old 04-29-2013
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Default Wild guess

Im making a wild guess. Its probably normal in pregnancy. Because flow murmurs are normal in pregnancy. And its also normal for S2 to split during inspiration.
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Old 04-29-2013
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Sistolic murmur at the left lower sternal border: related to tricuspid valve and sistolic murmur is a tricuspid regurgitation.
If this case was a diastolic murmur at the left lower sternal border it would be tricuspid stenosis.

Pronunced during inspiration: inspiration increases intensity of right heart sounds.

I think is a normal physiological response in pregnancy because an increase in blood volume.

A) Aortic stenosis --> clinical findings of AS are dyspnea, angina and syncope
B) Constrictive pericardial disease --> Pulsus paradoxus, kussmaul sign, increase in jugular venous pressure.
C) Hypertrophic cardiomyopathy --> Systolic murmur in apex, S4
D) Mitral insufficiency --> systolic murmur in the apex
E) Mitral Stenosis --> diastolic murmur in the apex
F) Normal physiological response
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Old 04-30-2013
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Default normal physiological response

F, it's my guess, but according to S2 is split during inspiration, it can be normal condition
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Old 01-15-2014
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thanks for the ans! Guys odd question but I cant figure how to start a new thread..I go to new posts but I dont see where it says to start new post. plz help someone! thank youu
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Old 01-17-2014
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Hey yeah is answer F, Murmurs are normal during pregnancy unless they go over an intensity of III/VI. And splitting of S2 during inspiration is normal. In facto I was once asked the physiologi reason of that
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Cardiovascular-, Clinical-Signs, Pathology-, Physiology-, Reproductive-, Step-1-Questions

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