An 18-year-old girl has dull retrosternal pain and shortness of breath. On examination she has a heaving apical pulse, an apical systolic thrill and a short mid-diastolic rumbling murmur. The most likely diagnosis is
a) mitral insufficiency
b) aortic stenosis
c) pericarditis
d) tricuspid incompetence
e) costochondritic pain
Answer:
a) mitral insufficiency
Explanation
In severe mitral insufficiency , signs of chronic heart failure are noted. The heart is enlarged, with a heaving apical left ventricular impulse and often an apical systolic thrill. The 2nd heart sound may be accentuated if pulmonary hypertension is present. A 3rd heart sound is usually prominent. A pansystolic murmur is heard at the apex radiating to the axilla. A short mid-diastolic rumbling murmur is caused by increased blood flow across the mitral valve as a result of the insufficiency