kpmle2
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A 25-year-old pregnant woman is referred to you for evaluation of a heart murmur that was noted during the second trimester of this pregnancy, which is her first. The patient has no history of cardiovascular disease, and the murmur was not heard during previous medical evaluations. She is asymptomatic. Examination shows a mildly displaced apical impulse and lower extremity edema. S1 and S2 are normal, and S3 is noted at the apex. A grade 2/6 early to mid-peaking systolic murmur is audible at the left sternal border. Based on the patients history and physical findings, which of the following is the most likely cause of the murmur?
A. Bicuspid aortic valve with mild to moderate stenosis
B. Congenitally abnormal pulmonary valve with moderate stenosis
C. Physiologic murmur related to pregnancy
D. Mitral valve regurgitation related to mitral valve prolapse
E. Bicuspid aortic valve with moderate regurgitation
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| Aashi
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C. Physiologic murmur related to pregnancy
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| Vietnamese
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C. Physiologic murmur related to pregnancy (due to output increase). But I do not understand why S3 is present in this case.
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| tamerbashir
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C
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| RX 135
tormenta
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S3 VOLUME OVERLOAD ...NORMAL
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| drduck
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murmur that peaks during mid or early systole......suggests AS
diamond shape murmur....very specific...
why not think about that??
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| cool doctor
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C
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| RX 135
tormenta
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left sternal pulmonary right
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| Ivonne
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C 
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| cool doctor
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what are the answers kpmle2?
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| kpmle2
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The correct answer is C
Recognize the physiologic murmur that is related to pregnancy.
During normal pregnancy, the physical findings may mimic those of heart disease. 83 is audible in more than 80% of normal pregnant women. An early peaking ejection systolic murmur is audible in more than 90% of normal pregnant women and is caused by a pulmonary outflow murmur. Left ventricular apical displacement is common because of the increase in blood volume that occurs during pregnancy. Later in pregnancy, apical displacement is accentuated as a result of cardiac displacement caused by increasing abdominal distension. Lower extremity edema is common during pregnancy and is caused by the increase in lower extremity venous pressure from the gravid uterus as well as the hormonal changes that occur during pregnancy.
In a patient in this age group, aortic valve stenosis would most likely be caused by a bicuspid aortic valve, and an ejection sound may be noted with this murmur. An aortic outflow murmur is usually best heard over the aortic area. Pulmonary valve stenosis is also commonly associated with a pulmonary ejection sound that decreases in intensity with inspiration. In addition, the right ventricle may be palpable in a patient who has pulmonary valve stenosis.
The murmur associated with mitral valve regurgitation is usually best heard at the apex. When associated with mitral valve prolapse, it often causes one or more systolic clicks. Aortic valve regurgitation is a diastolic murmur that does not correlate with the findings described in this patient.
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