A 30-year-old man was told that he had a heart murmur. Which of the following typically produces heart murmurs?
Dilated cardiomyopathy
Hypertensive heart disease
Ischemic heart disease
Restrictive cardiomyopathy
Valvular heart disease
The Correct Answer is E
A. Dilated cardiomyopathy: Dilated cardiomyopathy primarily causes systolic dysfunction and ventricular dilation. While it can lead to functional regurgitation due to annular dilation, it is not the classic cause of heart murmurs, which are most often due to structural valve abnormalities.
B. Hypertensive heart disease: Hypertensive heart disease leads to left ventricular hypertrophy and increased afterload. Although it can contribute to diastolic dysfunction, it does not directly produce heart murmurs unless secondary valvular changes occur.
C. Ischemic heart disease: Ischemic heart disease can cause myocardial infarction and regional wall motion abnormalities. Murmurs may develop as a secondary effect of papillary muscle dysfunction, but primary murmurs are not characteristic of ischemic heart disease.
D. Restrictive cardiomyopathy: Restrictive cardiomyopathy is characterized by impaired ventricular filling due to stiff ventricles. It may cause diastolic dysfunction but generally does not produce classic heart murmurs unless associated with secondary valvular involvement.
E. Valvular heart disease: Valvular heart disease, including stenosis or regurgitation of the mitral, aortic, tricuspid, or pulmonary valves, is the most common cause of heart murmurs. Turbulent blood flow across abnormal valves generates the audible sounds detected during auscultation, making it the primary source of murmurs in patients.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Acute myocardial infarction:Acute myocardial infarction can present with sudden collapse and hypotension, but it is uncommon in a young postpartum woman without significant coronary risk factors. The diastolic murmur and diminished pulses are not typical features of an MI.
B. Amniotic fluid embolism:Amniotic fluid embolism usually occurs during labor or immediately postpartum, presenting with sudden respiratory distress, hypotension, and coagulopathy. Collapse two days postpartum with a diastolic murmur and diminished pulses is less consistent with this condition.
C. Dissecting aortic aneurysm:Aortic dissection is suggested by sudden collapse, hypotension, diminished peripheral pulses, and a diastolic murmur of aortic regurgitation. A family history of early Marfan syndrome increases risk due to connective tissue weakness, making acute aortic dissection the most likely diagnosis in this postpartum patient.
D. Pulmonary thromboembolism:Pulmonary embolism can cause sudden collapse and dyspnea postpartum, but it rarely produces a diastolic murmur or diminished peripheral pulses. The presence of these cardiovascular signs points toward aortic pathology rather than pulmonary embolism.
E. Ruptured berry aneurysm:Ruptured cerebral aneurysms typically present with sudden severe headache, loss of consciousness, or neurological deficits. They do not explain the diastolic murmur or diminished pulses in the context of this patient’s cardiovascular collapse.
Correct Answer is B
Explanation
A. Acute left-sided heart failure:Left-sided heart failure typically presents with pulmonary congestion, dyspnea, orthopnea, and pulmonary rales. While it can eventually lead to right-sided symptoms, this patient’s presentation is dominated by right-sided signs—jugular venous distention, peripheral edema, hepatomegaly—without primary pulmonary edema, making left-sided failure less likely.
B. Cor pulmonale:Cor pulmonale is right ventricular enlargement and dysfunction caused by chronic pulmonary hypertension, often secondary to chronic lung diseases such as COPD. Features include peripheral edema, cyanosis, elevated jugular venous pressure, loud P2 due to pulmonary hypertension, hepatomegaly, and echocardiographic evidence of right ventricular dilation and hypertrophy. The patient’s history of severe COPD and chronic hypoxia strongly supports this diagnosis.
C. Pulmonary embolism:Pulmonary embolism can cause acute right heart strain and dyspnea, but it usually presents suddenly with chest pain, hemoptysis, and often without chronic signs such as peripheral edema or hepatomegaly. Echocardiography may show right ventricular dilation acutely, but chronic hypertrophy is not typical in isolated PE.
D. Dilated cardiomyopathy:Dilated cardiomyopathy affects both ventricles with progressive systolic dysfunction, leading to biventricular heart failure. While it can cause right-sided symptoms, the patient’s chronic COPD history and predominance of right-sided findings point to cor pulmonale rather than primary dilated cardiomyopathy.
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