A 24-year-old male presents with fatigue, poor exercise
tolerance and loss of weight. On
examination he looks underweight, pulse rate of 120 beats per minute regular.
The pulse volume decreases during inspiration.
His JVP is elevated 5 cms and the level increases during inspiration.
On auscultation of the heart sounds an early diastolic sound is audible at the
left sternal edge. On examination of the abdomen there is 4 fingerbreadths of
hepatomegaly and ascites.
In this patient the early diastolic added sound is due
Opening of a thickened atrioventricular valve
Rapid ventricular filling
Arrest of ventricular filling