BOF: 2.13
An 80-year-old male presents with a history of dyspnoea
and fatigue. On examination you find that the patient has a collapsing pulse
with positive Corrigan’s sign. The pulse pressure is wide. The JVP is not
elevated, his apex beat is displaced and thrusting in nature. On auscultation
the second heart sound is soft, there is a third heart sound and an
ejection click, a soft ejection systolic murmur and an early diastolic
murmur. The first heart sound is not loud and there is nor opening snap. At
the mitral area a mid-diastolic murmur is audible.
Lungs are clear on auscultation.
In this patient which of the following is not an
indicator of severity?
a)
Soft second heart sound
b)
Ejection click
c)
Third heart sound
d)
Mid-diastolic murmur at the apex
e)
Wide pulse pressure
Answer:
b)
The patient has clinical features of aortic regurgitation. The signs that correlate with severity are:
Wide pulse pressure
Soft second heart sound
Presence of a third heart sound
Duration of the early diastolic
murmur
Presence of an Austin Flint
murmur
Signs of left
ventricular failure
An ejection click suggests
that the patient has a bicuspid aortic valve and it is not related to severity
The mid-diastolic murmur at
the apex is likely to be an Austin Flint murmur and not due to mitral stenosis
as there is no opening snap and the first heart sound is not loud
Revision Tip
Revise severity of aortic
regurgitation ACES for PACES page 216
Revise aortic regurgitation
KEYS to SUCCESS in Medicine page 115-117
