Question:medium
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 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?
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Mitral stenosis with AF loses presystolic accentuation because atrial contraction is absent.
Updated On: May 14, 2026
- This patient has an increased risk of stroke
- The ‘a' wave is absent in the JVP
- This patient shows features of right heart failure
- Presystolic accentuation is a hallmark feature
Show Solution
The Correct Option is D
Solution and Explanation
Step 1: Understanding the Question:
The clinical features (history of RF, apical mid-diastolic murmur) indicate Mitral Stenosis (MS). The "irregularly irregular pulse" indicates Atrial Fibrillation (AF). We must identify the FALSE statement about this patient.
Step 2: Detailed Explanation:
Risk of Stroke (A): TRUE. The combination of Mitral Stenosis and Atrial Fibrillation is a extremely high-risk state for left atrial thrombus formation and systemic stroke.
JVP Findings (B): TRUE. The 'a' wave in the Jugular Venous Pulse is caused by atrial contraction. Since there is no organized atrial contraction in Atrial Fibrillation, the 'a' wave disappears.
Right Heart Failure (C): TRUE. Elevated JVP and tender hepatomegaly are classic signs of right-sided failure, usually secondary to pulmonary hypertension caused by chronic MS.
Presystolic Accentuation (D): FALSE. Presystolic accentuation of the MS murmur is caused by the atrial kick (atrial systole) pushing blood through the narrowed valve at the very end of diastole. Since this patient is in AF, there is no atrial kick. Therefore, the presystolic accentuation of the murmur is lost.
Step 3: Final Answer:
Statement D is false because presystolic accentuation disappears when a patient with Mitral Stenosis develops Atrial Fibrillation.
The clinical features (history of RF, apical mid-diastolic murmur) indicate Mitral Stenosis (MS). The "irregularly irregular pulse" indicates Atrial Fibrillation (AF). We must identify the FALSE statement about this patient.
Step 2: Detailed Explanation:
Risk of Stroke (A): TRUE. The combination of Mitral Stenosis and Atrial Fibrillation is a extremely high-risk state for left atrial thrombus formation and systemic stroke.
JVP Findings (B): TRUE. The 'a' wave in the Jugular Venous Pulse is caused by atrial contraction. Since there is no organized atrial contraction in Atrial Fibrillation, the 'a' wave disappears.
Right Heart Failure (C): TRUE. Elevated JVP and tender hepatomegaly are classic signs of right-sided failure, usually secondary to pulmonary hypertension caused by chronic MS.
Presystolic Accentuation (D): FALSE. Presystolic accentuation of the MS murmur is caused by the atrial kick (atrial systole) pushing blood through the narrowed valve at the very end of diastole. Since this patient is in AF, there is no atrial kick. Therefore, the presystolic accentuation of the murmur is lost.
Step 3: Final Answer:
Statement D is false because presystolic accentuation disappears when a patient with Mitral Stenosis develops Atrial Fibrillation.
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