A 74-year old woman with history of rheumatic fever (in her twenties) presented to her physician with complaints of increasing shortness of breath (dyspnea) upon exertion. The typical swelling she’s...

A 74-year old woman with history of rheumatic fever (in her twenties) presented to her physician with complaints of increasing shortness of breath (dyspnea) upon exertion. The typical swelling she’s had in her ankles for years has started to get worse over the past two months. In the past week, she’s had a decreased appetite, some nausea and vomiting and tenderness in the right upper quadrant of the abdomen. On physical examination, the patient’s jugular veins were noticeably distended. Auscultation of the heart revealed a low-pitched, rumbling systolic murmur, heard best over the left upper sternal border. In addition, she had an extra “S3” heart sound.

(i) What is causing this murmur?

(ii) Is the history of rheumatic fever relevant to the patient’s current symptoms? Explain.

(iii) Examination of the patient’s abdomen reveals an enlarged liver (hepatomegaly) and a moderate degree of ascites (‘water’ in the pericardial cavity). Explain these findings.

(iv) Examination of the patient’s ankles reveals significant “pitting oedema”. Explain this finding.

(v) What is the general term describing this condition?