Question

A 25-year-old woman presents with intermittent palpitations that are associated with lightheadedness; she admits to a past medical history of having a self-described "hole in her heart". These seem to occur upon significant exertion and when she is "stressed out." She denies chest pain, shortness of breath, wheezing, hemoptysis, cough, syncope, abdominal pain, rashes, peripheral edema, diaphoresis, and vomiting.

Her physical exam is remarkable for a mid-to-late systolic click; it is followed by a high-pitched, 'whooping' late systolic crescendo-decrescendo murmur, and it is heard best at the apex. The click occurs earlier with standing and upon Valsalva strain, and it also occurs later in the cardiac cycle with squatting and sustained handgrip.

What is the most likely diagnosis?
Aortic stenosis
2. Mitral valve prolapse
3 Ventricular septal defect
4 Aortic regurgitation
5 5 Mitral stenosis

Answer 1

The most likely diagnosis is Mitral valve prolapse, based on the symptoms and the characteristic heart sounds described.

Step-by-step explanation:

The most likely diagnosis for a 25-year-old woman presenting with intermittent palpitations, lightheadedness, and a history of a "hole in her heart," along with the physical examination findings of a mid-to-late systolic click followed by a 'whooping' late systolic crescendo-decrescendo murmur best heard at the apex, is Mitral valve prolapse. The description of the murmur and the systolic click, which occurs earlier with standing and upon Valsalva strain and later with squatting and sustained handgrip, are characteristic findings of mitral valve prolapse. This cardiac condition occurs when one or both of the mitral valve leaflets are too large and bulge (prolapse) into the left atrium during the heart's contraction.