06-03-2009, 01:40 PM
A 47-year-old man who has seen fit not to seek medical attention during his entire adult life since he has always been œhealthy as a horse finally visits a family practice physician to satisfy a requirement for a life insurance policy he wishes to obtain. Other than a particularly severe sore throat 15 years ago, he recalls no serious past illnesses. He takes no medications and does not smoke or drink. Vital signs are normal and notably on physical examination there is no cyanosis, clubbing, peripheral edema, abnormal jugular venous distension or abnormal hepatojugular reflux. Lungs are clear to auscultation and percussion. Auscultation reveals a nonradiating low-pitched 2/6 diastolic murmur that is preceded by a brief loud heart sound. This murmur is heard best at the apex with the patient in the left lateral decubitus position. No other murmurs are detected. Chest x-ray (CXR) shows no enhanced prominence of the pulmonary arteries, right atrial enlargement, or interstitial edema. A 12-lead electrocardiogram (ECG) shows sinus rhythm with a broad notched P-wave in lead II with negative terminal force in V1. Echocardiography confirms the presumptive diagnosis. What is a valid method to follow the asymptomatic progressive deterioration of the patient™s condition during the future examinations?
A. Murmur accentuation after isotonic or isometric exercise
B. Murmur accentuation during inspiration
C. Murmur duration
D. Murmur intensity
E. Murmur pitch
A. Murmur accentuation after isotonic or isometric exercise
B. Murmur accentuation during inspiration
C. Murmur duration
D. Murmur intensity
E. Murmur pitch