38-year-old female presents to the emergency department with the complaints of shortness of breath and fatigue...
A 38-year-old female presents to the emergency department with the complaints of shortness of breath and fatigue. History reveals the symptoms have been present for several months but have worsened within the past week. Past medical history reveals endocarditis. Medications include appetite suppressants for weight loss for over one year. Physical examination reveals a blowing holosystolic murmur radiating to the axilla, paravertebral fullness from T1-4, and a tender nodule in the 2nd intercostal space on the right adjacent to the sternum.
The most likely diagnosis is?
A. aortic regurgitation
B. aortic stenosis
C. mitral regurgitation
D. mitral valve prolapse
E. renal artery stenosis
The most accurate diagnostic test is?
A. transthoracic echocardiogram
B. transesophageal echocardiogram
C. CT of the chest with contrast
D. PA and lateral radiograph of the chest
E. carotid Doppler
The most likely diagnosis is?
mitral regurgitation
Mitral regurgitation occurs when an incompetent mitral valve is not able to seal properly during systole; therefore, a small amount of blood flows from the left ventricle back into the left atrium.
Both the history and physical findings in this case point to mitral regurgitation as the diagnosis.
Recent studies have shown that individuals taking fenfluramine or dexfenfluramine for more than four months have an increased risk of valvular damage.
This defect is also more common in patients with a history of endocarditis.
Ultimately, however, the physical finding of a blowing, holosystolic murmur with radiation to the axilla points to the diagnosis of mitral regurgitation.
As with any cardiac pathology, this patient presents with TART changes from T1-4 representing a viscerosomatic reflex from the underlying damage to the cardiac tissue. In addition we see a Chapman point in the second intercostal space near the sternum which is also commonly seen with any cardiac pathology.
#diagnosis
The most accurate diagnostic test is?
transesophageal echocardiogram (TEE)
Echocardiogram is the gold standard for diagnosing valvular diseases and is the primary means for assessing its severity.
Echocardiogram can be performed both transthoracic (TTE), as well as transesophageal (TEE) and allows visualization of the valves along with flow of blood through the heart’s chambers.
Transesophageal being more accurate to visualize posterior structures such as the MITRAL Valve.
Echocardiograms are used clinically to assess ejection fraction and ventricular pathologies that lead to cardiac morbidity and mortality.
#diagnostic