please try this cardiac question NB F2S1

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please try this cardiac question NB F2S1

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11 Posts

nadiabarati

03/01/06 - 08:44 AM

A 72-year-old woman comes to the physician because of an episode of acute substernal chest pain that occurred while she was rushing to catch a bus. She has basilar crackles at both lung bases. S1 is normal and S2 is decreased. A grade 3/6 systolic murmur is heard best at the upper right sternal border and radiates to the neck. The following data obtained during cardiac catheterization were taken before and during exercise:
Left ventricular volume Aortic P End diastolic End systolic Heart rate
(mm Hg) (mL) (mL) (/min)
Control 130/70 140 50 85
Exercise 160/80 165 58 120
While exercising, the patient has shortness of breath but no chest pain. Which of the following is the most likely cause of the shortness of breath?
A) Decreased cardiac output during exercise
B) Decreased pulmonary blood flow
C) Increased aortic pressure
D) Increased end-diastolic pressure of the left ventricle during exercise
E) Tachycardia

robin082006
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03/01/06 - 08:56 AM

Mitral insufficiency

I go with D

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dipti
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03/01/06 - 09:12 AM

nadiabarati

03/01/06 - 10:23 AM

I also agree with D

chazan
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03/01/06 - 11:17 AM

Could someone please post an explaination to this question. I'm sure you guys are right but dosen't a mitral regurge radiate to the axilla and a aortic stenosis radiate to the neck. Plus, Aortic stenosis is clinically associated with angina and syncope with exercise due to decreased cardiac output.

Please correct me if i am wrong and please explain

general malaise
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03/01/06 - 12:04 PM

i think its D but i believe its aortic stenosis. aortic murmurs are heard in second intercostal space right of the sternum

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nadiabarati

03/01/06 - 12:41 PM

chazan you are right that it's aortic stenosis and we have decreased CO during exercise but because the Q asks about the cause of shortness of breath I thought I should go for the direct cause of dyspnea. But I'm not sure, because A also seems reasonable choice to me..

ramo7
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03/01/06 - 01:36 PM

yes its aortic stenosis and not MR...mr will not radiate to neck but to axilla...answer is D..her aortic stenosis is causing her preload to increase..pressure build-up in the pulmonary vaculature resulting in oedema thus making her dyspneic and confirmed by the crackles heard on auscultation...

general malaise
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03/01/06 - 06:18 PM

what indication is there that there is mitral insufficiency?

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fleuve
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03/01/06 - 11:17 PM

#10

the question is what is the cause of dyspnea,

can mitral insuffficiency cause dyspnea?

i prefer a

nadiabarati

03/02/06 - 12:45 AM

#11

It's not mitral insuficiency!! It's aortic stenosis

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