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Forward to Regurgitant Flow Ratio

6486 Views 10 Replies 7 Participants Last post by  angermngment
this is one of the questions of uw...but i cudnt understand the plz guys help me wid dis one-:toosad:

A 46 yr old Caucasian female presents to ur office becoz of easy fatiguability n exertional dyspnea. Auscultation of heart reveals a diminished first heart sound and an apical holosystolic murmur radiating to d axilla. Lungs have bibasilar crackles. There is no elevation of JVP or peripheral edema. Which of d following wud most likely increase forward to regurgitant volume ratio in this patient?

A. Decreasing LV preload
B. Increasing LV contractility
C. Decreasing LV afterload
D. Decreasing heart rate
E. Increasing left ventricular volume
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So you're told the patient has a holosystolic murmur loudest at the apex that radiates to the axilla = Mitral Regurgitation.
By the way the decreased S1 is because your mitral and tricuspid valves close to produce S1 and your mitral valve is not closing that well because of the regurgitation.
You're also told the patient doesn't have a raised JVP or peripheral edema = NOT in heart failure
I would just like to make a small comment here. Please note that peripheral edema and a raised JVP are signs of right-sided heart failure. In the patient in question, we are dealing with mitral regurgitation, which (though rarely in isolation) can lead to left-sided heart failure. The mechanism is that regurgitation of blood flow from the left ventricle to the left atrium, will firstly cause left atrial enlargement due to increased left atrial pressure, and then, lead to pulmonary edema. This pulmonary edema can manifest itself on a plain chest film, or be revealed as crackles on auscultation, or, in the extreme case, may lead to paroxysmal nocturnal dyspnea and orthopnea.
In the question mentioned above, the patient is noted to have bibasilar crackles in the lung, which may be an early indication of pulmonary edema and hence, left-sided heart failure.
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