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 Best of Five 2.226

 

   

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BOF: 2.226

A 65 year old male who is known to have valvular heart disease and chronic heart failure is admitted to the ward for treatment of cellulitis of his right leg. The patient is on digoxin, diuretics and warfarin.

On examination of the patient you note that his pulse rate is 80 beats per minute irregular , not collapsing , BP 130/80, JVP elevated with a prominent V wave , apex displaced the 6th left intercostal space anterior axillary line , thrusting in nature , there was left parasternal heave , first heart sound was soft , there was a blowing pan systolic murmur at the apex and this radiated to the axilla, there was another pan systolic murmur at the left sternal edge which increased with inspiration and there was an early blowing decrescendo early diastolic murmur at the left sternal edge.

In this patient which of the following physical signs would enable you to determine the valvular origin of the blowing decrescendo early diastolic murmur at the left sternal edge?

a)      Thrusting apex beat

b)      Soft first heart sound

c)      Pulse not collapsing

d)     V wave

e)      Displaced apex

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