MEDICAL

A PREGNANT PATIENT WITH A HISTORY OF RHEUMATIC FEVER UNDERGOES ENDOCARDIOGRAPHY. WHICH OF THE FOLLOWING LESIONS IS MOST OMINOUS

  • A. Mitral stenosis with a 50% reduction in valve area ✓
  • B. Aortic stenosis with a 50% reduction in valve area
  • C. Severe mitral insufficiency without stenosis
  • D. Severe tricuspid insufficiency

 

The most ominous lesion in a pregnant patient with a history of rheumatic fever undergoing endocardiography would be Mitral stenosis with a 50% reduction in valve area.

Explanation:

  1. Mitral Stenosis with a 50% reduction in valve area: Mitral stenosis is a condition where the mitral valve, which separates the left atrium and left ventricle of the heart, becomes narrowed. In pregnancy, the increased blood volume and heart rate can exacerbate the symptoms of mitral stenosis. A 50% reduction in valve area indicates significant narrowing, which can lead to increased pressure in the left atrium and pulmonary congestion. This can result in heart failure, especially during the stress of pregnancy.
  2. Aortic Stenosis with a 50% reduction in valve area: Aortic stenosis is a condition where the aortic valve, which controls blood flow from the heart to the rest of the body, becomes narrowed. While aortic stenosis can also be serious, it is generally less affected by pregnancy compared to mitral stenosis. However, severe cases of aortic stenosis can still pose risks during pregnancy.
  3. Severe Mitral Insufficiency without Stenosis: Mitral insufficiency (or regurgitation) occurs when the mitral valve does not close properly, leading to backflow of blood into the left atrium. Severe mitral insufficiency can also be concerning during pregnancy due to increased blood volume and cardiac output but may not be as ominous as severe mitral stenosis.
  4. Severe Tricuspid Insufficiency: Tricuspid insufficiency is when the tricuspid valve between the right atrium and right ventricle does not close properly, causing backflow of blood into the right atrium. While tricuspid insufficiency can cause symptoms and complications, it is generally less ominous compared to significant lesions involving the mitral or aortic valves.

In summary, among the options provided, Mitral stenosis with a 50% reduction in valve area would be considered most ominous in a pregnant patient with a history of rheumatic fever undergoing endocardiography due to its potential impact on maternal and fetal outcomes.

In other words, Mitral stenosis can lead to complications during pregnancy due to the increased hemodynamic demands on the heart. The reduction in valve area further exacerbates the condition, potentially leading to adverse outcomes for both the mother and the fetus.

Mitral stenosis is particularly concerning during pregnancy because it can result in increased pressure in the left atrium and pulmonary circulation, leading to pulmonary edema and heart failure. The combination of pregnancy-induced changes in hemodynamics and pre-existing valvular lesions such as mitral stenosis can pose significant risks.

Aortic stenosis with a 50% reduction in valve area (option B) is also a serious condition that can lead to adverse outcomes during pregnancy. However, mitral stenosis is generally considered more ominous in this context due to its impact on pulmonary circulation and potential for pulmonary edema.

Severe mitral insufficiency without stenosis (option C) can also be problematic during pregnancy, as it may lead to volume overload and heart failure. Severe tricuspid insufficiency (option D) is less likely to cause significant issues during pregnancy compared to the other options provided.