A 39-year-old man suffers from chronic rheumatic heart disease. He complains of dyspnea during physical exertion, cough with expectoration, and palpitations. Auscultation detects intensified I heart sound and diastolic murmur; the sound of opening mitral valve can be auscultated at the cardiac apex. The II heart sound is accentuated over the pulmonary artery. The patient is cyanotic. X-ray shows dilated pulmonary root and enlargement of the right ventricle and left atrium. What is the most likely diagnosis?

Answer options

1. Pulmonary artery stenosis
2. Mitral stenosis
3. Patent ductus arteriosus
4. Aortic stenosis
5. Coarctation of the aorta

Explanation

A 39-year-old man suffers from chronic rheumatic heart disease. He complains of dyspnea during physical exertion, cough with expectoration, and palpitations. Auscultation detects intensified I heart sound and diastolic murmur; the sound of opening mitral valve can be auscultated at the cardiac apex. The II heart sound is accentuated over the pulmonary artery. The patient is cyanotic. X-ray shows dilated pulmonary root and enlargement of the right ventricle and left atrium. What is the most likely diagnosis?Mitral stenosis is a narrowing of the mitral valve opening that blocks (obstructs) blood flow from the left atrium to the left ventricle. Mitral stenosis usually results from rheumatic fever, but infants can be born with the condition. Mitral stenosis does not cause symptoms unless it is severe.Shortness of breath, especially with exertion or when you lie down. Fatigue, especially during increased physical activity. Swollen feet or legs. Heart palpitations — sensations of a rapid, fluttering heartbeat. Dizziness or fainting. Coughing up blood. Chest discomfort or chest pain. Common causes include aortic or pulmonary regurgitation and left anterior descending artery stenosis. Mid-diastolic murmurs start after S2 and end before S1. They are due to turbulent flow across the atrioventricular (mitral & tricuspid) valves during the rapid filling phase from mitral or tricuspid stenosis.