October 31, 2013

Concerning a man with valvular heart disease

A 56 year old male has a history of aortic stenosis. Which of the following is associated with aortic stenosis?
  1. Atrial fibrillation
  2. Systolic ejection murmur
  3. Increased pulse pressure
  4. Diastolic murmur
  5. Right heart failure

The correct answer is B

With aortic stenosis there is a systolic ejection murmur that is heard loudest at the second right intercostal space (the aortic area). A systolic ejection murmur is also seen with pulmonic stenosis, however this is best heard in the second left intercostal space.

Atrial fibrillation is common in mitral stenosis. It is also seen in mitral regurgitation, however, less commonly than with mitral stenosis. Aortic stenosis typically is not associated with atrial fibrillation.

The pulse pressure is the difference between systolic and diastolic pressure. An increased pulse pressure is seen with aortic regurgitation. It manifests itself with various signs: Quincke's sign, Duroziez's sign and a 'water hammer pulse'.

Diastolic murmur is heard with several different valvular conditions, including aortic regurgitation. A diastolic murmur is not heard with aortic stenosis. The murmur of aortic stenosis is heard during systole.

The symptoms of aortic stenosis include left ventricular failure (exertional syncope and angina are also symptoms). Ventricular arrhythmias may cause sudden death. A slow-rising pulse with narrow pulse pressure, thrusting apex, and harsh systolic ejection murmur (palpated as a thrill) at the aortic area radiating to the neck, which may or may not be preceded by an ejection click, is elucidated. A2 may be absent or paradoxically split.

1 comment:

  1. maggie.danhakl@healthline.com31 March 2014 at 22:23


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