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Difficulty: EasyCardiovascular System

Match the classic auscultatory physical exam findings described below with the most likely underlying valvular pathology.

  • Harsh crescendo-decrescendo systolic murmur radiating to the carotidsAortic stenosis
  • Holosystolic high-pitched blowing murmur radiating to the axillaMitral regurgitation
  • Early diastolic decrescendo murmur heard best at the left sternal borderAortic regurgitation
  • Mid-diastolic rumbling murmur preceded by an opening snapMitral stenosis

Answer

The accurate matches are: Harsh crescendo-decrescendo systolic murmur radiating to the carotids aligns with Aortic stenosis. Holosystolic high-pitched blowing murmur radiating to the axilla aligns with Mitral regurgitation. Early diastolic decrescendo murmur heard best at the left sternal border aligns with Aortic regurgitation. Mid-diastolic rumbling murmur preceded by an opening snap aligns with Mitral stenosis.
Each valvular lesion produces characteristic changes in blood flow that generate specific murmurs. Aortic stenosis creates a systolic outflow obstruction murmuring toward the neck. Mitral regurgitation creates a systolic backflow into the atrium, radiating laterally. Aortic regurgitation leaks in diastole along the sternal border, and mitral stenosis obstructs diastolic filling, heralded by an opening snap.

Step-by-Step Solution

1
Determine the timing of the murmur (systolic versus diastolic).
Murmurs 1 and 2 are systolic; Murmurs 3 and 4 are diastolic.
Timing narrows the differential diagnosis. Stenotic lesions of semilunar valves and regurgitant lesions of atrioventricular valves cause systolic murmurs.
2
Analyze the radiation and quality of the sound for each murmur.
Radiation to carotids indicates aortic outflow tract pathology (Aortic stenosis), while radiation to the axilla indicates a mitral pathology (Mitral regurgitation).
The direction of blood flow carrying the turbulent sound points to the specific valve involved.

Key Concept

Classic Auscultatory Findings of Valvular Heart Disease
Estimated Time:45s
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Topics

Cardiovascular System

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