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 Best of Five 2.1

 

   

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BOF: 2.1

A 65-year-old patient presents with a history of palpitations and breathlessness. She gives a history of Sydenham’s chorea as a child. On examination she has a pulse rate of 120 beats per minute rhythm; irregularly irregular, small volume. JVP not elevated, apex beat not displaced, tapping in nature. There is left parasternal heave, the first and second heart sounds are loud and there is an opening snap and a low-pitched rumbling mid-diastolic murmur. 

Which of the following physical signs suggest that a complication of her condition has occurred?

a)      Loud first heart sound

b)      Loud second heart sound

c)      Opening snap

d)      Mid-diastolic murmur

e)      Tapping apex

 

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