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Difficulty: HardCardiovascular System

Match each physical examination finding describing a characteristic cardiac murmur to the most likely underlying cardiovascular condition or pathology.

  • A mid-systolic click followed by a late systolic murmur; the click occurs earlier in systole upon abrupt standing.Mitral valve prolapse
  • A holosystolic murmur at the left lower sternal border that prominently increases in intensity during inspiration.Tricuspid regurgitation
  • An early diastolic decrescendo murmur that is auscultated best along the right sternal border.Aortic root dilation
  • A harsh, crescendo-decrescendo systolic murmur at the left lower sternal border that increases in intensity during the Valsalva maneuver.Hypertrophic cardiomyopathy
  • A mid-diastolic rumbling murmur with a presystolic accentuation, immediately following a high-pitched early diastolic sound at the apex.Mitral stenosis

Answer

L1 matches with Mitral valve prolapse; L2 matches with Tricuspid regurgitation; L3 matches with Aortic root dilation; L4 matches with Hypertrophic cardiomyopathy; L5 matches with Mitral stenosis.
Each physical examination finding uniquely describes the hemodynamics and acoustic properties of specific structural heart diseases, which can be distinguished using proper auscultation locations and dynamic bedside maneuvers.

Step-by-Step Solution

1
Analyze the murmur and dynamic maneuver in the first finding.
A click moving earlier in systole with standing indicates a smaller LV volume causing earlier prolapse.
Standing decreases preload. This is a classic feature of Mitral valve prolapse.
2
Evaluate the effect of inspiration on the second finding.
Inspiration increases right-sided murmurs (Carvallo's sign).
A holosystolic murmur at the left lower sternal border that increases with inspiration points to Tricuspid regurgitation.
3
Locate the maximal intensity point for the third finding.
An early diastolic murmur best heard at the right sternal border suggests aortic root pathology.
Valvular aortic regurgitation is best heard at the left sternal border, whereas aortic root dilation murmurs project to the right sternal border.
4
Determine the hemodynamic change during Valsalva for the fourth finding.
Valsalva decreases preload, worsening the murmur.
This behavior is characteristic of Hypertrophic cardiomyopathy, where reduced LV volume worsens the outflow tract obstruction.
5
Identify the components of the fifth finding.
An opening snap followed by a mid-diastolic rumble with presystolic accentuation.
These classic auscultatory findings are the hallmark of Mitral stenosis.

Key Concept

Differentiation of structural heart diseases and valvular pathologies through careful auscultation and dynamic maneuvers.
Estimated Time:2m 0s
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Cardiovascular System

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