A patient was admitted to the ICU 3 days ago with a diagnosis of myocardial infarction

Question

The patient is complaining of increased chest pain when coughing, swallowing, and changing positions. The nurse hears a systolic scratching sound upon auscultation of the apical pulse. The nurse notifies the physician. Based on the symptoms, the physician suspects a(n)

a. acute mitral regurgitation.
b. aortic insufficiency.
c. chronic mitral regurgitation.
d. pericardial friction rub.

Answer 1

D
A pericardial friction rub is a sound that can occur within 2 to 7 days after a myocardial infarction. The friction rub results from pericardial inflammation (pericarditis). Classically, a pericardial friction rub is a grating or scratching sound that is both systolic and diastolic, corresponding to cardiac motion within the pericardial sac. Acute mitral regurgitation occurs when the ventricle contracts during systole and a jet of blood is sent in a retrograde manner to the left atrium, causing a sudden increase in left atrial pressure, acute pulmonary edema, and low CO and leading to cardiogenic shock. Chronic mitral regurgitation is auscultated in the mitral area and occurs during systole. It is high pitched and blowing, although the pitch and intensity vary, depending on the degree of regurgitation. As mitral regurgitation progresses, the murmur radiates more widely. Aortic insufficiency is an incompetent aortic valve. If the valve cusps do not maintain this seal, the sound of blood flowing back into the left ventricle during diastole is heard as a decrescendo, high-pitched, blowing murmur.