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Increased pulmonary vascular compliance
9%
12/134
Decreased pulmonary artery systolic pressure (PASP)
4%
5/134
Increased left ventricular end diastolic pressure (LVEDP)
28%
38/134
Normal or decreased left ventricular end diastolic pressure (LVEDP)
49%
65/134
Decreased transmitral gradient
3%
4/134
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This patient most likely has mitral stenosis (MS), which causes increased pressure proximal to the stenosis, sparing the left ventricle. This patient presents with signs and symptoms of heart failure, and on exam has a murmur consistent with mitral stenosis (MS). MS causes increased pressure proximal to the stenosis, and can result in increased pulmonary capillary wedge pressure, increased PA systolic pressure, loss of pulmonary vascular compliance, a dilated RV, and perhaps functional tricuspid regurgitation. However, it is important to note that the left ventricle is spared and does NOT experience increased pressure, and so PCWP is not an accurate measure of LVEDP. Indeed, the gradient between the PCWP (which should be equal to left atrial pressure) and the left ventricle is used to grade the severity of MS. Illustration A demonstrates the classic "fish mouth" appearance of a stenotic mitral valve. Incorrect Answers: Answer 1: Pulmonary vascular compliance is decreased in MS. Answer 2: PASP is increased in MS. Answer 3: LVEDP is typically normal in MS. Answer 5: This patient has signs of severe MS, and likely has an increased transmitral gradient.
3.2
(17)
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