Match each patient's clinical presentation with the most likely corresponding auscultatory finding and its characteristic response to dynamic maneuvers.
- A 22-year-old athlete with a family history of sudden cardiac death experiences exertional syncope.Crescendo-decrescendo systolic murmur at the left lower sternal border that increases in intensity during the strain phase of the Valsalva maneuver.
- A 78-year-old man presents with exertional dyspnea and demonstrates a delayed and diminished carotid pulse.Late-peaking systolic ejection murmur at the right second intercostal space that decreases in intensity upon standing.
- A 28-year-old woman with Marfan syndrome presents with occasional palpitations and atypical chest pain.Late systolic murmur with a preceding click that moves closer to the first heart sound (S1) upon standing.
- A 45-year-old man with a history of untreated syphilis presents with widened pulse pressure and bounding peripheral pulses.Early diastolic decrescendo murmur best heard along the left sternal border that increases in intensity with sustained handgrip.
- A 4-week-old infant with poor weight gain, tachypnea, and diaphoresis during feeding.Harsh holosystolic murmur at the left lower sternal border that increases in intensity with sustained handgrip.
Answer
Hypertrophic cardiomyopathy matches with the systolic murmur that increases with Valsalva; aortic stenosis matches with the late-peaking murmur that decreases upon standing; mitral valve prolapse matches with the click that moves closer to S1 upon standing; aortic regurgitation matches with the diastolic murmur that increases with handgrip; and ventricular septal defect matches with the holosystolic murmur that increases with handgrip.
Each accurate match links a classic clinical presentation of a structural or valvular cardiac abnormality with its expected auscultatory findings, specifically evaluating the pathophysiological principles of how dynamic maneuvers alter cardiac hemodynamics and murmur intensity.
Step-by-Step Solution
Key Concept
Identifying valvular and structural heart diseases from clinical vignettes and correlating them with characteristic murmur alterations induced by bedside hemodynamic maneuvers.