Question

32-year-old woman w/ significant SOB x6 mos. occasional dry cough at night. immigrated from Guatemala 8 years ago. S1 is loud. With the patient positioned on her left side and breath held at the end of expiration, a diastolic murmur is heard at mid- and end diastole. Which of the following are the most likely left ventricular hemodynamic findings at rest in this patient? A) Elevated left ventricular end-diastolic pressure B) Reduced left ventricular end-systolic volume C) Decreased left ventricular compliance D) Increased left ventricular afterload

Answer 1

The patient's symptoms and physical examination suggest elevated left ventricular end-diastolic pressure, which is likely due to a condition like mitral stenosis causing increased pressure in the left atrium and pulmonary hypertension.

Step-by-step explanation:

Given the symptoms and physical examination findings of a diastolic murmur heard at mid- and end-diastole in this patient, the most likely left ventricular hemodynamic finding at rest would be A) Elevated left ventricular end-diastolic pressure. During auscultation, the clinician asked the patient to hold her breath after expiration, which amplified left-sided heart murmurs. A loud S1 and diastolic murmur heard during expiration can indicate a heart condition that results in elevated left ventricular end-diastolic pressure. This could be due to a condition like mitral stenosis.

Mitral stenosis is a narrowing of the mitral valve in the heart. This obstructs the blood flow from the left atrium to the left ventricle, leading to an increase in pressure in the left atrium and ultimately, pulmonary hypertension. Symptoms can include shortness of breath, which the patient has reported experiencing for six months, and a dry cough at night.

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