DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
117. A 58 year old man presents to his physician for his yearly checkup. His past medical history is remarkable for rheumatic fever. On physical examination, the physician notes that the loud, snapping S1 sound heretofore present in this patient is now much softer in intensity. Which of the following is suggested by this physical finding?
A. Regurgitant, immobile aortic valve
B. Regurgitant, mobile mitral valve
C. Regurgitant, mobile tricuspid valve
D. Stenosed, immobile mitral valve
E. Stenosed, mobile aortic valve
(PLEASE EXPLAIN ANSWER!)
Thanks.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| doc179
Forum Guru
Topics: 67
Posts: 1,217
|
I think its B . chronic rheumatic fever causes mitral valve prolapse.
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
right answer is D!!
Can anyone explain?
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| general malaise
Forum Guru
Topics: 14
Posts: 433
|
B man had mitral prolapse which can sometimes lead to valve insuficiency
___________________
"El respeto al derecho ajeno es la paz" Benito Juarez
|
| robin082006
Forum Hero
Topics: 471
Posts: 5,125
|
Mitral valve prolapse or stenosis?
I think MV stenosis is more common in RF, so answer is D
___________________
The Key to Succeed is Patience.
|
| fruit
Forum Senior
Topics: 1
Posts: 89
|
Guys this is B; h/o RF present and look at hi age>58yrs. Mitral stenosis comes in youger age , long standing cases gives rise valve insufficiency and so do the decrease in snap.
|
| dr_vetri
Forum Newbie
Topics: 4
Posts: 13
|
right answer is D. though the pt is 58 now, he wud hav had the history of mitral stenosis. and thats the reason for his loud snapping s1..
loud s1 is due to snapping of mitral leaflet while blood tries to flow down a stenosed valve.
as the mitral leaflet gets sclerosed and more stenosed, the mobility is reduced. so the pt no more has a loud s1.
intensity of 1st heart sound is inversely proportional to stenosis of mitral valve.
|
| rm
Forum Senior
Topics: 16
Posts: 77
|
i agree with dr_vetri. over time a as a valve under goes further stenosis it loses the intensity of its mumur.
|
| doc179
Forum Guru
Topics: 67
Posts: 1,217
|
I was wrong the ans is D. when the mitral valve gets calcified and sclerosed which is usually the case with chronic rheumatic fever we hear a soft S1. recurrent episodes of rheumatic fever leads to sclerosis of the mitral valve ( fish mouth appearance ) from stenosis.
So now I wonder ...when would the mitral valve prolapse as one of the causes of mitral alve prolapse is chronic rheumatic fever. may be they would say in the stem of the question that the patient died suddenly or he had a loud snapping S1 and now we hear a regurgitation...something like that?
would be really helpful if somebody explained this to me. Thank you very much
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
Ok to clear up some doubt:
The right given answer is D.
According to Goljan:
Carditis in RF: (Pericarditis, Myocarditis, and Endocarditis)
Endocarditis: sterile vegetations on line of closure of the valve.
The endocarditis leads to mitral regurg (not stenosis) BUT Mitral Stenosis can occur and takes years to develop, so Mitral Stenosis is the MCC of CHRONIC Rheumatic Heart Disease.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| doc179
Forum Guru
Topics: 67
Posts: 1,217
|
I got it  Thank you. rheumatic fever causes mitral regurgitation and recurrent attacks make the valve stenotic,sclerosed and calcified.
most common cause of mitral regurgitation is mitral valve prolapse and other causes include rheumatic fever, infective endocarditis, papillary muscle rupture, left ventricular dilation from CCF.
and most common causes of mitral valve prolapse are Ehler danlos and marfans...
|
| mitty
Forum Guru
Topics: 52
Posts: 376
|
the key word in the q is soft(muffled) S1, which is sign of MS so D is the answer
___________________
He will make it happen.
|
| fruit
Forum Senior
Topics: 1
Posts: 89
|
thanx guys
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
Good summary of MVP. thanks doc179.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| docsrinu
Forum Elite
Topics: 26
Posts: 213
|
thanku doc179 & Docvirgo..
|
|
| |
| | | | | | | | | | | | | | | |
