07-23-2009, 07:07 AM
6. A 37-year-old woman comes to the physician because of progressive shortness of breath over the past 5 years; she now has fatigue and shortness of breath with mild exertion. She has a history of mitral stenosis secondary to rheumatic fever at the age of 15 years. She was asymptomatic until 5 years ago when she developed severe shortness of breath during pregnancy. She was treated with diuretics, low-sodium diet, and bed rest, and she was able to deliver the baby at term. Her only medication is hydrochlorothiazide. Her temperature is 37 C (98.6 F), blood pressure is 110/80 mm Hg, pulse is 100/min and regular, and respirations are 26/min. Cardiac examination shows an obvious opening snap in S2. A grade 3/6, late diastolic murmur is heard at the apex. A right ventricular lift is palpated along the left sternal border. Which of the following is most likely increased in this patient?
A
) Blood flow to the lower lung fields
B
) Diastolic filling time
C
) Left-to-right shunt of blood
D
) Left ventricular end-diastolic pressure
E
) Pulmonary artery pressure
A
) Blood flow to the lower lung fields
B
) Diastolic filling time
C
) Left-to-right shunt of blood
D
) Left ventricular end-diastolic pressure
E
) Pulmonary artery pressure