A 32-year-old nursing student who had rheumatic fever as a child noticed a persi

Question

A 32-year-old nursing student who had rheumatic fever as a child noticed a persistent tachycardia and light-headiness. Upon examination, thoracic radiographs showed an enlarged left atrium and left ventricle. ECG analysis showed atrial fibrillation. There was also mild pulmonary congestion. Cardiac evaluation resulted in the following information: Cardiac Output (CO) 3.4 L/min (5 L/min) Blood Pressure (BP) 100/58 mm Hg (120/80 mm Hg) Left Arterial Pressure (LAP) 16 mm Hg (2 – 12 mm Hg) Right Ventricular Pressure (RVP) 44/8 mm Hg (25/0-5 mm Hg) Heart sound also revealed valvular regurgitation. 1. Based on the information provided, which A-V valve is incompetent, allowing the regurgitation? 2. Which heart sound would be pronounced and lengthened? 3. Describe, using surface anatomy, the location at which this valvular disorder could best be heard. 4. If the other A-V valve were incompetent instead of this one, would the CO, BP, LAP, and RVP differ? If so, how? 5. What are the causes of the tachycardia, light-headedness, and mild pulmonary congestion? 6. Describe the pathogenesis of Rheumatic Fever (if there is any) in this cardiovascular disease state.

Explanation / Answer

1. Based on thr given information the mitral valve between the left atrium and left ventricle is causing this regurgitation.

2. The first heart sound or S1 will be pronounced and will be lenghtened. It is the closing sound of the mitral valves.

3. The mitral valve is located in between the left atrium and left ventricle and if someone wishes to hear the S1 heart sound then it can be best heard from the fifth intercostal space medial to the left clavicular line.

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