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Mehlman Cardiology Practice Exam

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In a 40-year-old man with a history of rheumatic fever as a child and a rumbling diastolic murmur, which finding in childhood history is most likely?
Correct Answer:
Mitral regurgitation
Explanation:
The key idea is that rheumatic heart disease often starts with mitral valve inflammation during the acute rheumatic fever episode, leading to mitral regurgitation. Over years this valve can progress to chronic scarring and fusion of the valve apparatus, resulting in mitral stenosis a long time later, which produces the rumbling diastolic murmur heard at the apex. So in someone who currently has a diastolic rumble (mitral stenosis) and a history of rheumatic fever in childhood, it’s most likely that, during childhood, there was an episode of rheumatic fever with mitral valve involvement presenting as mitral regurgitation. The other conditions don’t fit this pattern of rheumatic valve disease progression and don’t explain the diastolic rumble.

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