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  #1  
Old 03-15-2011
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Heart Pick the right heart valve lesion

A 27-year-old man comes to the physician complaining of increasing dyspnea on exertion. Over the past 3 weeks, he has noted increasing shortness of breath while walking to the bus stop, three blocks from his home. He has also found it difficult to sleep comfortably while lying flat and now sleeps on three pillows. He has awoken several times in the past month with shortness of breath. He denies any history of chest pain. He does not smoke, and his cholesterol tests were normal 1 year earlier. On physical examination, he appears comfortable at rest. His blood pressure is 158/56 mm Hg, pulse is 86/min and regular, and respirations are 16/min. He has jugulovenous distention while being examined at 30 degrees. His lungs have bibasilar rales. On cardiac examination, there is a regular S1 and S2, with a blowing diastolic murmur heard loudest at the left sternal border. A I/VI systolic murmur is heard throughout the precordium. An extra heart sound immediately following the S2 is heard. There is mild lower extremity pedal edema bilaterally. What is the most likely cause of his symptoms?


1-Mitral regurgitation
2 Aortic stenosis
3-Tricuspid stenosis
4-Pulmonary valve stenosis
5-Mitral stenosis
6-Mitral regurgitation
7-Tricuspid regurgitation
8-Aortic insufficiency
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  #2  
Old 03-15-2011
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This is a typical presentation of acute aortic regurgitation presentation with overt heart failure.

Infective endocarditis would be the first underlying aetiology that needs to be ruled out!

E
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Old 03-15-2011
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I think it is aortic insufficiency:

-Diastolic murmur
-Widened pulse-pressure
-Heard best at L sternal border
-Extra heart sound might be an S3
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Old 03-15-2011
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An additional note to be aware-high BP particularly systolic BP in such a young fit and healthy man!

It is common in acute decompensated heart failure. It is normal body physiological response to reduced cardiac output by activating sympathetic nervous system.
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Old 03-16-2011
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Save It! E

I ll agree with E.............. as 1TAB explained
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Old 05-01-2011
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Nice case, I think it's Aortic regurgitation
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