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Forward to Regurgitant Flow Ratio

6488 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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yup, or, otherwise, you can look at it like it is in first aid...

On p. 255 on the 2010 fa, we find that a "holosystolic, high pitched "blowing murmur" is either mitral or tricuspid regurg. It's not in the tricuspid area, so this is mitral regurg.

Okay - since we've established that, in the description, it says "enhanced by maneuvers that increase tpr (squatting, hand grip) or la return (expiration)

so, since this is a regurg, then we know that anything which increases the murmur must increase the backward flow and therefore the opposite is true for increasing the forward flow.

So, anything which decreases tpr or la return would decrease the backward flow and therefore the murmur. Decreasing lv afterload would decrease tpr. Tadaa...
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