John is a 35-year-old nurse who had rheumatic fever as a child. He noticed a persistent tachycardia and light-headedness. Chest x-rays showed an…

John is a 35-year-old nurse who had rheumatic fever as a child. He noticed a persistent tachycardia and light-headedness. Chest x-rays showed an enlarged left atrium and left ventricle. ECG analysis showed atrial fibrillation and 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. Deduce which A-V valve is incompetent, thus allowing the regurgitation.
  2. Using anatomical terms, describe the location at which this valvular disorder could best be heard.
  3. Which heart sound would be pronounced and lengthened?
  4. If the other AV 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?

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