USMLE Forum Archives - USMLE Step 3 - IM: Cardiology
IM: Cardiology
meduploader - 06-01-09 06:31
A 45-year-old man is evaluated for atrial fibrillation. His past history is remarkable for tetralogy of Fallot, which was repaired when he was 3 years old. He has had no other surgery and has not had regular cardiovascular follow-up since that time.
Physical examination demonstrates a blood pressure of 128/68 mm Hg and a heart rate of 78 beats per minute in atrial fibrillation. A displaced apical impulse and a prominent parasternal impulse are noted. A normal S1 and single S2 are noted. A holosystolic and a diastolic murmur are noted at the lower left sternal border (fourth intercostal space), both of which increase with inspiration. The chest radiograph demonstrates right-sided cardiac chamber enlargement and dilatation of the pulmonary arteries. The electrocardiogram demonstrates atrial fibrillation with right bundle branch block and a heart rate of 76/min.
What is the most likely cause for this patient's physical findings and symptoms?
meduploader - 06-01-09 06:31
A 45-year-old man is evaluated for atrial fibrillation. His past history is remarkable for tetralogy of Fallot, which was repaired when he was 3 years old. He has had no other surgery and has not had regular cardiovascular follow-up since that time.
Physical examination demonstrates a blood pressure of 128/68 mm Hg and a heart rate of 78 beats per minute in atrial fibrillation. A displaced apical impulse and a prominent parasternal impulse are noted. A normal S1 and single S2 are noted. A holosystolic and a diastolic murmur are noted at the lower left sternal border (fourth intercostal space), both of which increase with inspiration. The chest radiograph demonstrates right-sided cardiac chamber enlargement and dilatation of the pulmonary arteries. The electrocardiogram demonstrates atrial fibrillation with right bundle branch block and a heart rate of 76/min.
What is the most likely cause for this patient's physical findings and symptoms?
The correct answer and explanation will be available after you answer.
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#22
Re: IM: Cardiology 2010med - 11-06-09 13:48 My answer is: d.
because it is in the mytral valve area
#36
Re: IM: Cardiology conym5 - 04-14-10 13:30 This patient had longstanding severe pulmonary valve regurgitation that eventually resulted in right-sided cardiac chamber enlargement and the development of tricuspid valve regurgitation, annular and atrial dilatation, and atrial fibrillation.
#47
Re: IM: Cardiology babbu5508 - 08-31-10 00:24 My answer is: b.
Pulmonary valve regurgitation A holosystolic and a diastolic murmur are noted at the lower left sternal border (fourth intercostal space), both of which increase with inspiration...indicates right sided valve disease
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