Match each clinical presentation and characteristic physical examination finding with the most likely underlying valvular pathology.
- A 24-year-old woman with a mid-systolic click followed by a late systolic murmur that becomes longer and louder with the Valsalva maneuver.Mitral valve prolapse
- A 68-year-old man with syncope, a delayed carotid upstroke, and a harsh crescendo-decrescendo systolic murmur at the right upper sternal border.Aortic valve stenosis
- A 45-year-old man with a bounding pulse, head bobbing, and a high-pitched, blowing early diastolic decrescendo murmur at the left sternal border.Aortic valve regurgitation
- A 32-year-old woman with hemoptysis, a loud first heart sound (S1), and a low-pitched mid-diastolic rumbling murmur at the cardiac apex.Mitral valve stenosis
Answer
The mid-systolic click with Valsalva accentuation matches mitral valve prolapse; the delayed carotid upstroke with a harsh systolic murmur matches aortic valve stenosis; the bounding pulse with an early diastolic murmur matches aortic valve regurgitation; and the loud S1 with a mid-diastolic rumble matches mitral valve stenosis.
Each clinical vignette presents a pathognomonic set of physical exam findings for a specific valvular lesion. A mid-systolic click with a late systolic murmur that worsens with decreased preload points to mitral valve prolapse. A delayed carotid upstroke with a harsh right-sided systolic murmur indicates aortic valve stenosis. Bounding pulses with an early diastolic murmur reveal aortic valve regurgitation. A loud S1 with a mid-diastolic rumbling murmur is characteristic of mitral valve stenosis.
Step-by-Step Solution
Key Concept
Valvular Heart Disease Physical Examination Findings