A 28-year-old woman who is 7 months pregnant presents with orthopnea and paroxysmal nocturnal dyspnea. Vital signs show BP 145/92 mmHg, HR 108/min, RR 22/min, SpO2 92% on room air. Examination reveals a pansystolic murmur at the apex radiating to the axilla that decreases with handgrip maneuver. Chest X-ray shows pulmonary edema. She denies recent fever or intravenous drug use. Which of the following is the most likely diagnosis?
- A)Aortic stenosis
- B)Pulmonary embolism
- C)Peripartum cardiomyopathy
- D)Mitral stenosis
- E)Mitral regurgitationGABARITO
Explicação
Mitral regurgitation presents with a holosystolic (pansystolic) murmur at the apex radiating to the axilla. It decreases with handgrip (increased afterload increases forward flow). Pregnancy increases cardiac output and can unmask or worsen MR, leading to pulm... Ver explicação completa e trilha adaptativa →