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Old 10-28-2011
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Heart hallmark of mitral stenosis

A 38-year-old Asian immigrant presents for the evaluation of exertional dyspnea with minimal activity. His past medical history is significant for acute rheumatic fever. He denies any fever, chest pain, cough, malaise or weight loss. His PR: 70/min and regular; BP: 126/76mmHg; Temperature: 37.2C(99F). His apex beat is tapping and non-displaced. Auscultation of his lungs shows crepitations in both lower lung fields. Auscultation of heart reveals a loud first heart sound, mid-diastolic rumbling and a low-pitched murmur at the apex with an opening snap. The murmur is accentuated by mild exercise. Chest X-ray shows straightening of the left border of the heart and presence of Kerley B lines. EKG shows left atrial enlargement. Which of the following findings is a hallmark of the suspected disease?

a. Left atrial enlargement
b. Elevated left atrioventricular pressure gradient
c. Wide pulse pressure
d. Elevated left ventricular diastolic pressure
e. Atrial fibrillation
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Old 10-28-2011
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option b.elevated left atrioventricular pressure gradient
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Old 10-28-2011
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B.elev left AV pressure

Akua
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Old 10-28-2011
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why cant it b LA enlargement??
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Default yes the answer is elevated Left AV pressure

Quote:
Originally Posted by sonu.agarwall View Post
why cant it b LA enlargement??
The hallmark finding of MS is elevated left atrioventricular pressure gradient that ultimately leads to left atrial enlargement. The elevated left atrial pressures are transmitted to the pulmonary veins, capillaries, and arteries. These phenomena are responsible for the exertional dyspnea and later, pulmonary hypertension and right heart failure. Enlargement of the left atrium predisposes to the development of atrial fibrillation which is quite common in mitral stenosis but is not the hallmark finding.
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Old 10-28-2011
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ohkanswers can be so narrow in CK.....heard from my seniors....
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