Question

A 45-year-old female presents with 6-month history of paroxysmal nocturnal dyspnea, palpitations and breathlessness. JVP is elevated, pulse is irregularly irregular, tender hepatomegaly is present, apex is heaving, and a mid-diastolic murmur is heard at the apex. She has a history of acute rheumatic fever. Which statement is false?

• A. This patient has an increased risk of stroke
• B. The ‘a' wave is absent in the JVP
• C. This patient shows features of right heart failure
• D. Presystolic accentuation is a hallmark feature

Hint:

Mitral stenosis with AF loses presystolic accentuation because atrial contraction is absent.

Answer 1

The Correct Option is D

Concept: The patient has rheumatic mitral stenosis with atrial fibrillation and right heart failure features. In atrial fibrillation, atrial contraction is lost.

Step 1: Identify disease.
Mid-diastolic murmur at apex with rheumatic fever history suggests: \[ \text{Mitral stenosis} \]

Step 2: Identify rhythm.
Irregularly irregular pulse suggests: \[ \text{Atrial fibrillation} \]

Step 3: Understand why option D is false.
Presystolic accentuation occurs due to atrial contraction. In atrial fibrillation, atrial contraction is absent, so presystolic accentuation disappears. Therefore, the false statement is: \[ \text{Presystolic accentuation is a hallmark feature} \]