A 52-year-old man comes to the physician because of increasing fatigue over the last 2 weeks. He has also been experiencing exertional dyspnea and occasional headaches. He has no chest pain or lower extremity swelling or significant medical history. The patient was healthy as a child and received all his childhood vaccinations. Blood pressure is 145/90 mm Hg and pulse is 80/min and regular. Physical examination reveals a holosystolic murmur best heard at the apex of the heart that radiates to the axilla. The lungs are clear on auscultation and abdominal examination is unremarkable. Which of the following is the best indicator of the severity of this patient's valve disease?

Question

A 52-year-old man comes to the physician because of increasing fatigue over the last 2 weeks.  He has also been experiencing exertional dyspnea and occasional headaches.    He has no chest pain or lower extremity swelling or significant medical history.  The patient was healthy as a child and received all his childhood vaccinations.  Blood pressure is 145/90 mm Hg and pulse is 80/min and regular.  Physical examination reveals a holosystolic murmur best heard at the apex of the heart that radiates to the axilla.  The lungs are clear on auscultation and abdominal examination is unremarkable.  Which of the following is the best indicator of the severity of this patient's valve disease?

Quizplus · Accepted Answer

Eductional Objective: Patients with severe mitral regurgitation develop left-sided volume overload with an S3 gallop due to the large volume of regurgitant flow reentering the ventricle during mid-diastole.  The absence of an S3 gallop excludes severe chronic MR.

A 52-Year-Old Man Comes to the Physician Because of Increasing