question-cardio

[Hero]

58-year-old man with recent onset of chest pain (angina) and orthopnea is found to have bounding pulses, syst. HTN, loud ejection click at the apex, and a short midsystolic ejection murmur at the base followed by a decrescendo diastolic murmur along the left sternal border. The correct answer is:
1.Mitral stenosis
2.Mitral valve prolapse
3.Papillary muscle dysfunction
4.Aortic regurgitation

[Hero]

Aortic regurgitation is the correct answer.
Chronic AR usually remains asymptomatic for a period despite cardiac enlargement before angina and dyspnea manifest. A wide pulse pressure is caused by increased stroke volume followed by a rapid runoff. A vigorous opening of the aortic valve results in a loud ejection click at the apex. The midsystolic murmur is caused by increased systolic stroke volume ejected rapidly into the aorta while the diastolic murmur results from the backward flow of blood into the left ventricle.

[bharat]

Originally Posted by Hero

Aortic regurgitation is the correct answer.
Chronic AR usually remains asymptomatic for a period despite cardiac enlargement before angina and dyspnea manifest. A wide pulse pressure is caused by increased stroke volume followed by a rapid runoff. A vigorous opening of the aortic valve results in a loud ejection click at the apex. The midsystolic murmur is caused by increased systolic stroke volume ejected rapidly into the aorta while the diastolic murmur results from the backward flow of blood into the left ventricle.

hey hero! hi how is your vaccation? well i was out of city for few days and i once saw your question while i was out andi was thinking to reply but i was confused between stenosis/ regurgitation because "short midsystolic ejection murmur at the base followed by a decrescendo diastolic murmur along the left sternal border" was suggestive of stenosis as far i am concerned because in stenosis there is low pitched murmer but other sypmtoms like "chest pain (angina) and orthopnea,syst. HTN, loud ejection click at the apex" were suggestive of Regurgation so i was thinking of writing answer after i returned to my collage but u replyed yourself( oh i missd it 1 point gone bro.).
well thanks for the answer.
ok i am waiting for more question and at last how is your summer vaccation?

[Hero]

Dear Bharat. I went to Yunnan for few days, had lots of fun there.now started to go ward .
As u have mentioned that murmur in AS is low pitched-generally u will hear low pitch murmur at the apex only, while in 2nd RICS u will hear harsh, diamond shaped systolic murmur. In this patient, short midsystolic murmur is due to large volume ejection in AR. and the typical murmur of AR is early diastolic--these all are present in this patient and thus suggest for AR. My experience is that the murmurs are not always so typical as we used to listen in audio samples and what we study in books. Its really very difficult to tell the type of murmur (in most cases). The most important thing u should bear in mind is the character of pulse--especially when u r confused either it is AS or AR. In this patient the arterial pulse is bounding--suggest AR coz in AS pulse is low volume and slow rising. You may also look for Pulse pressure for differentiation. Chest pain and most importantly orthopnea in this patient suggest that the patient has LHF (functional status) due to AR (Dx).

[Hero]

Bharat, all r sleeping..no one is interested in discussion. but u too lost somewhere

[bharat]

Originally Posted by Hero

Bharat, all r sleeping..no one is interested in discussion. but u too lost somewhere

hey bro. iam here not asleep
well these days oak bro. have been away so no one is intended to discuss but i am ready don't worry bro go on posting i will participate as soon as posible.
well these days i am little busy sleeping hahah it's vacation bro
well hope for your response soon.

[bharat]

Originally Posted by Hero

Bharat, all r sleeping..no one is interested in discussion. but u too lost somewhere

heyhye bro. well have you ever downloaded any files from http://rapidshare.de/files/12435452/...tions.pdf.html
well i tried but never been sucessfull so if you have please send me some bro. i would be greatfull. and how did you celbrated Jani purnima yeasterday bro?

[Hero]

Originally Posted by bharat

heyhye bro. well have you ever downloaded any files from http://rapidshare.de/files/12435452/...tions.pdf.html
well i tried but never been sucessfull so if you have please send me some bro. i would be greatfull. and how did you celbrated Jani purnima yeasterday bro?

What is there? I haven't downloaded any from that site. Is this Janai Purnima today? Haha, I was busy whole day drinking pijiu. Anyway, have a nice time.