Do not confuse

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Do not confuse

Post  Mohammad Tayeb on Thu Dec 27, 2007 10:15 am

A 25 years old male is seen in the clinic for routine physical examination. He has no complaint & he is asymptomatic with no episode of syncope & has no family history of cardiac disease. Systolic murmur is heard at the right lower sternal border. On valsalva maneuver the murmur decrease in intensity, & it is accentuated with inspiration. What is the probable diagnosis? Why?
A. Aortic regurgitation.
B. Mitral regurgitation.
C. Tricuspid regurgitation.
D. Pulmonary stenosis.
E. HOCM.
F. Flow murmur.

Mohammad Tayeb

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Re: Do not confuse

Post  Ahmed Al-Kaisy on Fri Dec 28, 2007 12:45 am

hi doc, iam not 100% sure about my answer but i depended a way of exclusion to reach the answer, i hope it is right...

- since it is a systolic murmur, so we should exclude: aortic regurgitation and pulmonary stenosis (diastolic murmurs).

- since it is decreased by valsalva maneouver, we should exclude HOCM.

- since it is accentuated by inspiration, it means that is a murmur on the right side..so u should exclude mitral regurgitation..

so, i guess a tricuspid regurgitation would be an appropriate answer...

Ahmed Al-Kaisy

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Re: Do not confuse

Post  Mohammad Tayeb on Fri Dec 28, 2007 4:52 am

That is right dear ahmed....inspiration increases venous return to the right side of the heart so increases the sound of tricuspid regurgitation...valsava maneuver (also standing) both decrease preload thereby decrease the sounds of most systolic murmurs with primary exceptions are HOCM & mitral valve prolapse.

Mohammad Tayeb

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Re: Do not confuse

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