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Retired NBME 23 Answers

nbme23/Block 4/Question#17 (reveal difficulty score)
A 24-year-old man has a grade 3/6 systolic ...
Aortic stenosis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—jrod77(32)
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The systolic pressure difference between the left ventricle and the aorta in this pt. is pretty significant, Whereas in a normal heart those systolic pressures should be just about equal. This hints at the fact that the left ventricle has to put in alot of work to push through the aortic valve. That extra pressure goes into opening the valve and does not appear in the aorta.

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divya  why is left atrial pressure normal while pulm arterial and right ventricular pressures are high? +6
leaf_house  @divya It looks like the left atria can dilate in response to severe aortic stenosis, which I think would bring up the minimum diastolic pressure of LA (and I guess lower max systolic pressure?) like dilated cardiomyopathy. Link: https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.116.005156 +
cbreland  @divya I was on the same page, I saw that the left atrium was normal so I went to look at the right side of the heart and saw pressure elevations. Went with pulmonic stenosis.. Jumped the gun๐Ÿ˜” +
jbrito718  @divya I think it has to do with the fact that the left ventricle is pumping so hard that some RV hypertrophy may occur since they contract simultaneously. Chronic aortic stenosis will eventually reflect backwards, causing increased pulmonary vessel resistance. +



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