Question

A 40-year-old female patient came with complaints of chest pain, palpitation, and shortness of breath. On examination, a mid-diastolic murmur was heard, and a prominent 'a' wave was found on JVP. What is the most likely diagnosis?

• A. Mitral stenosis
• B. Tricuspid stenosis
• C. Mitral regurgitation
• D. Tricuspid regurgitation

Answer 1

The Correct Option is B

A 40-year-old female patient presents with symptoms including chest pain, palpitations, and shortness of breath. A mid-diastolic murmur is detected during the examination, along with a prominent 'a' wave on the jugular venous pulse (JVP). These clinical findings point towards a potential problem associated with one of the heart valves.

Analysis of Symptoms and Examination Findings:

• Mid-diastolic murmur: This type of murmur is typically associated with the narrowing of a valve. In this context, the valves of interest are the mitral and tricuspid valves.
• Prominent 'a' wave on JVP: This feature classically indicates an increased right atrial pressure which is often observed in cases of tricuspid stenosis because the obstruction causes difficulty in right atrial emptying during systole, leading to elevated pressures.

Diagnosis:

Given the combination of a mid-diastolic murmur and a prominent 'a' wave, the most logical diagnosis among the provided options is Tricuspid stenosis. This condition leads to a mid-diastolic murmur due to blood flow restriction from the right atrium to the right ventricle and an 'a' wave due to right atrial contraction against a narrowed valve.

Condition	Key Characteristics
Tricuspid stenosis	Mid-diastolic murmur, prominent 'a' wave
Mitral stenosis	Mid-diastolic murmur, opening snap
Mitral regurgitation	Holosystolic murmur, radiates to axilla
Tricuspid regurgitation	Holosystolic murmur, increased with inspiration