A 46-year-old woman comes to the emergency department due to progressive dyspnea over the last 2 days. The patient's exercise tolerance has decreased dramatically and she had to sleep in a sitting position last night. She has no history of cardiovascular disease. The patient does not use tobacco or alcohol. Family history is unremarkable. Blood pressure is 110/65 mm Hg and pulse is 105/min and regular. The apical impulse is hyperdynamic. Auscultation reveals crackles at the lung bases, an S3 gallop, and a II/VI holosystolic murmur over the apex. The patient is admitted to the hospital, and after treatment with diuretics and vasodilators his condition improves significantly. Three days later there are no appreciable gallops or murmurs on cardiac examination. Which of the following best explains the murmur heard at the time of the initial examination?

Question

A 46-year-old woman comes to the emergency department due to progressive dyspnea over the last 2 days.  The patient's exercise tolerance has decreased dramatically and she had to sleep in a sitting position last night.  She has no history of cardiovascular disease.  The patient does not use tobacco or alcohol.  Family history is unremarkable.  Blood pressure is 110/65 mm Hg and pulse is 105/min and regular.  The apical impulse is hyperdynamic.  Auscultation reveals crackles at the lung bases, an S3 gallop, and a II/VI holosystolic murmur over the apex.  The patient is admitted to the hospital, and after treatment with diuretics and vasodilators his condition improves significantly.  Three days later there are no appreciable gallops or murmurs on cardiac examination.  Which of the following best explains the murmur heard at the time of the initial examination?

Quizplus · Accepted Answer

Eductional Objective: Decompensated heart failure is a common cause of secondary (functional) mitral valve regurgitation.  Increased left ventricular end-diastolic volume causes dilation of the mitral valve annulus and restricted movement of the chordae tendineae with subsequent regurgitation.  Treatment with diuretics and vasodilators can improve heart failure-induced MR.

A 46-Year-Old Woman Comes to the Emergency Department Due to Progressive