RE: 38-year-old female presents to the emergency department with the complaints of shortness of breath and fatigue...
The most likely diagnosis is?
mitral regurgitation
Mitral regurgitation occurs when an incompetent mitral valve is not able to seal properly during systole; therefore, a small amount of blood flows from the left ventricle back into the left atrium.
Both the history and physical findings in this case point to mitral regurgitation as the diagnosis.
Recent studies have shown that individuals taking fenfluramine or dexfenfluramine for more than four months have an increased risk of valvular damage.
This defect is also more common in patients with a history of endocarditis.
Ultimately, however, the physical finding of a blowing, holosystolic murmur with radiation to the axilla points to the diagnosis of mitral regurgitation.
As with any cardiac pathology, this patient presents with TART changes from T1-4 representing a viscerosomatic reflex from the underlying damage to the cardiac tissue. In addition we see a Chapman point in the second intercostal space near the sternum which is also commonly seen with any cardiac pathology.