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 Best of Five 2.13

 

   

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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

 

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