vallia
Forum Guru
Topics: 98
Posts: 889
|
A high school basketball player passes out in the middle of a game. He
is rushed to the emergency room, where he regains consciousness. He
claims that just before he fainted, he had difficulty breathing and
experienced palpitations. On physical exam, he has a bifid apical
impulse and a coarse systolic murmur at the left sternal border.
The echocardiogram reveals ventricular hypertrophy with asymmetric
septal thickening. Which of the following would increase the intensity
of his heart murmur?
A. Elevating his legs
B. Increasing sympathetic tone
C. Performing the Valsalva maneuver
D. Squatting
___________________
fight possessed
|
| general malaise
Forum Guru
Topics: 14
Posts: 433
|
A.....increases venous return to right side of the heart?
___________________
"El respeto al derecho ajeno es la paz" Benito Juarez
|
| babli
Forum Guru
Topics: 40
Posts: 425
|
C. Performing the Valsalva maneuver
|
| mitty
Forum Guru
Topics: 52
Posts: 376
|
D
___________________
He will make it happen.
|
| robin082006
Forum Hero
Topics: 471
Posts: 5,125
|
A
___________________
The Key to Succeed is Patience.
|
| vallia
Forum Guru
Topics: 98
Posts: 889
|
The correct answer is C. This patient has hypertrophic cardiomyopathy-the most common cause of sudden cardiac death in young patients. It usually causes problems during exertion. Clues to the diagnosis include: dyspnea, palpitations, bifid apical impulse, coarse systolic murmur at the left sternal border, and ventricular hypertrophy with asymmetric septal thickening on echocardiogram. Left ventricular outflow obstruction typically plays an important role in the pathophysiology of this condition. Maneuvers that decrease preload, such as the Valsalva maneuver, will accentuate the heart murmur because they result in less ventricular filling, contributing to greater outflow obstruction.
Elevating his legs (choice A), increasing sympathetic tone (choice B), and squatting (choice D) would all increase venous return and would therefore diminish the murmur.
___________________
fight possessed
|
|
| |
| | | | | | |
