Answer :USMLE step 2 Mcq 287:An 18-year-old girl has dull retrosternal pain and shortness of breath

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Correct Answer: A

Explanation:
In severe mitral insufficiency , signs of chronic heart failure are noted. The heart is enlarged, with a heaving apical left ventricular impulse and often an apical systolic thrill. The 2nd heart sound may be accentuated if pulmonary hypertension is present. A 3rd heart sound is usually prominent. A pansystolic murmur is heard at the apex radiating to the axilla. A short mid-diastolic rumbling murmur is caused by increased blood flow across the mitral valve as a result of the insufficiency


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