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The right ventricle is compensating with decreased compliance
2%
3/126
The left atrium is compensating with increased compliance
64%
81/126
The aorta is compensating with increased compliance
6%
8/126
As long as preload in the left ventricle is maintained there would be no symptoms
18%
23/126
There is only a ballooning of the valve which would not result in any hemodynamic changes in the heart
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The patient in this vignette most likely has chronic mitral regurgitation, based on her lack of symptoms and characteristic murmur. Chronic mitral regurgitation is characterized by an increased left atrial compliance. Mitral regurgitation can be caused by rheumatic fever, chordae tendon rupture, or mitral valve prolapse. This valvular disorder results in retrograde blood flow into left atria and can present with a range of symptoms including dyspnea, orthopnea, and fatigue. Symptoms develop if regurgitation develops acutely or if the atria can no longer compensate in a chronic problem. Chest auscultation reveals a holosystolic murmur that radiates to the axillae. Illustration A demonstrates the dilation of the left atrium in chronic MR when compared to acute MR. Incorrect Answers: Answer 1: The right ventricle plays no role in chronic, compensated mitral regurgitation. Answer 3: The aorta plays no role in chronic, compensated mitral regurgitation. Answer 4: This describes hypertrophic obstructive cardiomyopathy which would not present with an asymptomatic holosystolic murmur. Answer 5: This describes mitral valve prolapse, which would not present with a holosystolic murmur (rather a click and murmur).
3.7
(18)
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