CARDIOLOGY

Recognize the clinical presentation of atrial myxoma and those of mitral stenosis.

Explanation:

Atrial myxoma falls forward into the mitral valve orifice when the patient bends forward. This blocks flow to the LV  and decrease ventricular filling.

Cardiac output drops and therefore syncope occurs in this position. It can also lead to embolic and vasculitic phenomenon like infective endocarditis. One may hear a  diastolic PLOP sound as it falls forward - I do not expect us to recognize this sound but some examiners do! Investigation of choice is Echo and treatment is resection.

It causes sudden, severe mitral stenosis.

Rheumatic mitral stenosis is a commonly asked scenario. It is associated with a loud 1st heart sound. A diastolic rumble that is best heard in expiration while the patient lies in the left lateral position. Mitral valve replacement is required only in the presence of symptoms like shortness of breath or multiple embolic phenomena.