Valvular Heart Disease — Clinical

Which of the following is the most common cause of acute severe aortic regurgitation in a previously asymptomatic patient?

A 58-year-old man from rural Maharashtra presents with progressive dyspnea on exertion for 3 months and orthopnea for 1 week. He has a history of acute rheumatic fever at age 12. On examination, blood pressure is 140/90 mmHg, pulse 88/min regular, JVP elevated at 6 cm. Auscultation reveals a loud S1, an opening snap 80 ms after A2, and a mid-diastolic murmur best heard at the apex in the left lateral decubitus position. Chest X-ray shows pulmonary edema with straightening of the left heart border. ECG shows atrial fibrillation with a ventricular rate of 92/min and left atrial enlargement. What is the most likely diagnosis?

A 58-year-old man with a 10-year history of rheumatic heart disease presents with dyspnea on exertion and orthopnea. On examination, he has an opening snap followed by a mid-diastolic murmur best heard at the apex with the patient in the left lateral decubitus position. Echocardiography confirms mitral stenosis with a valve area of 1.2 cm². Regarding the clinical features and management of mitral stenosis, all of the following are true EXCEPT:

A 52-year-old woman with a history of infective endocarditis 6 months ago now presents with progressive dyspnea and a new diastolic murmur. Echocardiography shows aortic regurgitation with a regurgitant jet width of 65% of the aortic root diameter. Regarding the clinical assessment and management of aortic regurgitation, all of the following statements are correct EXCEPT:

A 52-year-old man with a history of rheumatic fever presents with dyspnea and palpitations. On examination, he has an opening snap and a low-pitched diastolic murmur at the apex. Echocardiography confirms mitral stenosis. Which single clinical or echocardiographic feature best distinguishes mitral stenosis from mitral regurgitation?