Which of the following signs and symptoms would most likely be found in a client with mitral regurgitation?
A. Exertional dyspnea
B. Confusion
C. Elevated creatine phosphokinase concentration
D. Chest pain
Correct Answer: A. Exertional dyspnea
Weight gain, due to fluid retention and worsening heart failure, causes exertional dyspnea in clients with mitral regurgitation. The rise in left atrial pressure that accompanies mitral valve disease is transmitted backward into pulmonary veins, capillaries, and arterioles and eventually to the right ventricle. Signs and symptoms of pulmonary and systemic venous congestion follow.
Option B: On auscultation, S1 may be diminished in acute mitral regurgitation (MR) and chronic severe MR with defective valve leaflets, and wide splitting of S2 may occur due to early closure of the aortic valve. S3 may be present due to LV dysfunction or as a result of increased blood flow across the mitral valve.
Option C: Usually holosystolic, may be confined to early systole in acute MR, may be confined to late systole in MVP or papillary muscle dysfunction (S1 will probably be normal in these cases since initial closure of mitral valve cusps is unimpeded, and a midsystolic click preceding murmur is suggestive of MVP)
Option D: Murmurs are usually high-pitched, blowing. Usually best heard over the apex; usually radiates to the left axilla or subscapular region: posterior leaflet dysfunction causes murmur to radiate to the sternum or aortic area, and anterior leaflet dysfunction causes murmur to radiate to the back or top of the head.
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