An 82-Year-Old Man Is Evaluated for a Heart Murmur

question 947

Multiple Choice

An 82-year-old man is evaluated for a heart murmur.  He states that he feels healthy.  On review of systems, he has had no chest pain, dyspnea, lightheadedness, syncope, or lower extremity swelling.  The patient walks several miles per day.  He has a history of hypertension treated with amlodipine.  He is a lifetime nonsmoker.  Blood pressure is 145/60 mm Hg and pulse is 72/min and regular.  The lungs are clear on auscultation.  Echocardiogram reveals a calcified aortic valve without stenosis but with severe aortic regurgitation.  The left ventricle is dilated with an ejection fraction of 63%.  No other valvular abnormalities are noted.  Which of the following compensatory mechanisms best explains why this patient is asymptomatic with the existing pathology?

• A)Decreased forward stroke volume
• B)Decreased left ventricular contractility
• C)Decreased left ventricular preload
• D)Increased left ventricular compliance
• E)Increased total peripheral resistance

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Definitions:

Minimum Annual Income

The lowest yearly income deemed necessary for a person or family to meet their basic living expenses.

Necessities

Necessities are basic needs or essential items required for living, such as food, clothing, and shelter.

Ability-To-Pay Principle

A taxation principle that suggests taxes should be levied according to an individual or entity's ability to afford them, often implying higher taxes for those with higher income.

Pigouvian Subsidies

Financial incentives given by the government to encourage activities that have positive external effects on society.