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a prev healthy 42 yr old woman comes to the physician coz of a 6 mth h/o sob with mod exertn and pulsatile tinnitus in her left ear. She has had 2 dec her daily running from 40 min to 20 min at a slower pace. She takes no medicn. Her lmp was 5 wks ago. She is sexually active and uses a diaphragm for contraception. She appears well. Her bp is 130/60mm hg, pulse is 96/min and respi are 16/min. a bruit is heard over the lft ear. The lungs are clear 2 auscultn. A gd 2/6 early systolic murmur is heard at the lft sternal border. The cardiac apex is lat displaced and enlarged. Peripheral pulses are bounding. An ecg shows no abn except for lvh. Echo shows a lvef of 50% and an inc lv end diast vol. which of the foll is the most likely diagn?

a. aortic stenosis
b. arteriovenous malformation
c. hypertrophic cardiomyopathy
d. osteitis deformans(paget™s ds)
e. pregnancy
f. vit b1 def

aaaaa

i dont understand why is there bounding peripheral pulse, should be weak pulse with AS like a pulsus parvus et tardus


Bounding peripheral pulse would be in AR or PDA..............

other possibility could be an AVM but not with the kinda murmur present here

BBBB.....murmur is not of aortic stenosis but its a flow murmur due to hyperdynamic circulation.

Plus she has wide pulse pressure, increase LV end diastolic pressure and bounding pulses.....all s/o hyperdynamic circulation.

BB.

bruit at two sites with high cardiac output.

got it thanks guys,,,,,,,,,,its like a tell-tale murmur in VSD due to excess flow

sorry not increase LVED pressure but LVED volume...