Examkin

Question

Difficulty: EasyCardiovascular System

Match each classic valvular abnormality to its most characteristic physical examination finding on cardiac auscultation.

  • Aortic stenosisCrescendo-decrescendo systolic murmur best heard at the right upper sternal border with radiation to the carotids
  • Mitral regurgitationHolosystolic murmur best heard at the apex with radiation to the left axilla
  • Aortic regurgitationEarly diastolic decrescendo murmur best heard at the left sternal border
  • Mitral stenosisMid-diastolic rumbling murmur with a loud S1 and a prominent opening snap

Answer

Aortic stenosis matches the crescendo-decrescendo systolic murmur. Mitral regurgitation matches the holosystolic murmur. Aortic regurgitation matches the early diastolic decrescendo murmur. Mitral stenosis matches the mid-diastolic rumbling murmur.
Each valvular lesion produces a unique acoustic signature based on the timing of blood flow and the anatomical location of the valve. Aortic stenosis and mitral regurgitation are systolic murmurs, distinguished by their shape (crescendo-decrescendo vs. holosystolic) and radiation. Aortic regurgitation and mitral stenosis are diastolic murmurs, distinguished by their timing in diastole and associated sounds like the opening snap.

Step-by-Step Solution

1
Identify the timing of the murmurs relative to the cardiac cycle.
Two murmurs occur during systole (the crescendo-decrescendo and holosystolic murmurs), and two occur during diastole (the early decrescendo and mid-diastolic rumbling murmurs).
Categorizing murmurs as primarily systolic or diastolic is the most reliable first step in narrowing down potential valvular defects.
2
Correlate the systolic murmurs with their specific valvular pathologies.
The crescendo-decrescendo murmur corresponds to aortic stenosis, while the holosystolic murmur corresponds to mitral regurgitation.
Aortic stenosis involves forward flow obstruction during ventricular ejection, creating a rising and falling sound. Mitral regurgitation involves backward flow into the atrium driven by a constant pressure gradient, creating a uniform systolic sound.
3
Correlate the diastolic murmurs with their specific valvular pathologies.
The early diastolic decrescendo murmur matches aortic regurgitation, and the mid-diastolic rumble with an opening snap matches mitral stenosis.
Aortic regurgitation involves abnormal backward flow that peaks early in diastole. Mitral stenosis involves obstructed forward filling of the ventricle, classically heralded by an opening snap as the stiff valve is forced open.

Key Concept

Auscultatory features of classic valvular heart diseases
Rate this question

Topics

Cardiovascular System

More questions from this topic