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NBME 21 Answers

nbme21/Block 3/Question#19

A 25-year-old woman develops increasing shortness ...

Four-chamber dilation

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Peri- or postpartum cardiomyopathy (PPCM) is a rare, life-threatening heart disease of unclear origin and is characterized by heart failure of sudden onset between the final weeks of pregnancy and 6 months after delivery. link to pubmed The clinical picture of PPCM corresponds to a dilated cardiomyopathy (DCM) with signs of severe heart failure.

maxillarythirdmolar  For anyone wanting to understand why^ the tl;dr is that prolactin gets cleaved into two toxic metabolites. Treatment is something like bromocriptine (and therefore no more breast feeding) to stop prolactin release. Lastly, you can treat with regular HF meds. +1  

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submitted by hungrybox(255),

jugular venous distention = left heart failure

pulmonary edema = right heart failure

Four-chamber dilation is the most likely answer.

Other answers:

  • Assymetric septal hypertrophy, myocardial disarray: these are both classic findings in hypertrophic cardiomyopathy (HCM)
  • endocardial fibroelastosis: a rare restrictive cardiomyopathy seen in infants/children
  • lymphocytic infiltration of the myocardium: seen in viral (autoimmune) myocarditis. A cause of dilated cardiomyopathy, but there was no mention of a preceding viral illness.
meningitis  I think you meant: Jugular venous distention = LT HF Pulmonary edema = RT HF +3  
hungrybox  woops yea I meant Jugular venous distention = RIGHT HF, Pulmonary edema = LEFT HF +3  

I thought of it as pregnancy being a volume overload state, which causes dilated cardiomyopathy.

Not sure if this was the correct reasoning, but other comments seem very detailed.