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Difficulty: EasyCardiovascular System

Match each classic auscultatory finding with its most likely underlying valvular pathology.

  • Harsh crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotidsAortic valve stenosis
  • Holosystolic, high-pitched blowing murmur at the apex radiating to the axillaMitral valve regurgitation
  • Mid-diastolic, low-pitched rumbling murmur with a preceding opening snap heard best at the apexMitral valve stenosis
  • Early diastolic, high-pitched decrescendo murmur heard best at the left sternal border while the patient is leaning forwardAortic valve regurgitation

Answer

The auscultatory findings map to their respective valvular lesions based on murmur timing, character, location of maximal intensity, and typical radiation patterns.
Each auscultatory finding corresponds to a specific hemodynamic derangement. Aortic stenosis creates an ejection murmur due to a narrowed valve orifice. Mitral regurgitation allows systolic backflow, creating a holosystolic murmur. Mitral stenosis obstructs diastolic ventricular filling, yielding a rumble and an opening snap. Aortic regurgitation permits diastolic backflow, producing a decrescendo murmur.

Step-by-Step Solution

1
Analyze the timing and location of the crescendo-decrescendo systolic murmur.
The murmur is at the right upper sternal border with carotid radiation, mapping to aortic valve stenosis.
Turbulent blood flow across a narrowed aortic valve during ventricular systole creates this classic ejection murmur.
2
Evaluate the holosystolic apical murmur.
The murmur radiates to the axilla, mapping to mitral valve regurgitation.
Retrograde blood flow from the left ventricle into the left atrium throughout the entirety of systole produces a blowing holosystolic murmur.
3
Assess the diastolic murmur with an opening snap.
The opening snap and mid-diastolic rumble at the apex map to mitral valve stenosis.
The sudden tensing of the fibrotic mitral valve leaflets causes the snap, followed by turbulent flow into the ventricle during diastole.
4
Examine the early diastolic decrescendo murmur.
Heard at the left sternal border, especially while leaning forward, this maps to aortic valve regurgitation.
Backflow from the higher-pressure aorta into the left ventricle during diastole creates this high-pitched decrescendo murmur.

Key Concept

Valvular Heart Disease Auscultation
Estimated Time:1m 0s
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Topics

Cardiovascular System

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