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NBME 21 Answers

nbme21/Block 3/Question#19

A 25-year-old woman develops increasing shortness ...

Four-chamber dilation

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submitted by haliburton(64),

Peri- or postpartum cardiomyopathy (PPCM) is a rare, life-threatening heart disease of unclear origin and is characterized by heart failure of sudden onset between the final weeks of pregnancy and 6 months after delivery. link to pubmed The clinical picture of PPCM corresponds to a dilated cardiomyopathy (DCM) with signs of severe heart failure.

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submitted by hungrybox(148),

jugular venous distention = left heart failure

pulmonary edema = right heart failure

Four-chamber dilation is the most likely answer.

Other answers:

  • Assymetric septal hypertrophy, myocardial disarray: these are both classic findings in hypertrophic cardiomyopathy (HCM)
  • endocardial fibroelastosis: a rare restrictive cardiomyopathy seen in infants/children
  • lymphocytic infiltration of the myocardium: seen in viral (autoimmune) myocarditis. A cause of dilated cardiomyopathy, but there was no mention of a preceding viral illness.
meningitis  I think you meant: Jugular venous distention = LT HF Pulmonary edema = RT HF +2  
hungrybox  woops yea I meant Jugular venous distention = RIGHT HF, Pulmonary edema = LEFT HF +2