Cardiovascular Case Histories - Case 13

A 32-year-old nurse who had rheumatic fever as a child noticed a persistent tachycardia and light-headedness. Upon examination, chest x-rays showed an enlarged left atrium and left ventricle. ECG analysis showed atrial fibrillation. There was also mild pulmonary congestion. Cardiac evaluation resulted in the following information:
Cardiac output (CO) 3.4 L/min
Blood pressure (BP) 100/58 mm Hg
Left atrial pressure (LAP) 16 mm Hg
Right ventricular pressure (RVP) 44/8 mm Hg
Heart sounds revealed valvular regurgitation.

1. Based on the information provided, which A-V valve is incompetent, allowing the regurgitation?

2. Which heart sound would be pronounced and lengthened?

3. Describe, using surface anatomy, the location at which this valvular disorder could best be heard.

4. If the other A-V valve were incompetent instead of this one, would the CO, BP, LAP, and RVP be different? If so, how?

5. What are the causes of the tachycardia, light-headedness, and mild pulmonary congestion?

6 Calculate the pulse pressure (PP) and mean arterial pressure (MABP) for this individual.
a. PP =.
b. MABP =.

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