A 41-year-old intravenous drug abuser has shortness of breath and pleuritic chest pain. He is febrile with a temperature of 39.5, He has no skin lesions and funduscopic exam is negative. He has jugular venous distension that increases with compression of the abdomen. The liver is pulsatile. The jugular venous pulse shows a prominent v wave. The patient has splenomegaly, Heart auscultation reveals a pansystolic murmur heard best at the left lower sternal border. The murmur increases with inspiration Which of the following is the most likely diagnosis?
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الإجابة: B. Tricuspid valve endocarditis
Febrile IV drug user with a pansystolic murmur at the left lower sternal border that increases with inspiration, prominent v waves, positive hepatojugular reflux and a pulsatile liver = tricuspid regurgitation, i.e. tricuspid valve endocarditis. Mitral/aortic lesions do not increase with inspiration, and MVP gives a mid-systolic click, not fever with right heart signs.
ليش كل خيار صح أو غلط
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A
ليش غلط
Aortic valve endocarditis produces an early diastolic murmur (aortic regurgitation), not a pansystolic murmur that increases with inspiration.
✓ CARDIOLOGY- VHD+IE.pdf · p. 17 -
B
ليش صح
Tricuspid regurgitation shows prominent v waves, a pulsatile liver and a holosystolic murmur at the LLSB that intensifies with inspiration; tricuspid endocarditis occurs in IV drug users.
✓ Step Up To Medicine 6th (Valvular Heart Disease).pdf · p. 7 -
C
ليش غلط
Mitral regurgitation gives a holosystolic murmur at the apex radiating to the back or clavicular area; it is not the murmur that is loudest at the LLSB and rises with inspiration.
✓ Step Up To Medicine 6th (Valvular Heart Disease).pdf · p. 6 -
D
ليش غلط
MVP gives a mid-systolic click with a mid-to-late systolic murmur, and most patients are asymptomatic. It does not explain fever, pulsatile liver and v waves.
✓ Step Up To Medicine 6th (Valvular Heart Disease).pdf · p. 8
- المصدر
- Step Up To Medicine 6th (Valvular Heart Disease).pdf · p. 7
- المحاضرة
- Valvular Heart Disease · Cardiology · Module B
- ظهر في
- Cardio bank