Aortic Regurgitation: The Daily PANCE Blueprint

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Aortic Regurgitation: The Daily PANCE Blueprint

A 20-year-old male basketball player presents to the clinic for an annual exam. He has extremely long limbs, fingers, and a positive wrist sign. His vitals show hypertension (144/72 mmHg). Which of the following murmur are you likely to hear?

A. Early diastolic blowing murmur best heard at the left sternal border
B. Systolic ejection murmur at the second left intercostal space with a fixed widely split S2
C. Continuous murmur heard best at the lower left sternal border
D. Systolic murmur at the third left intercostal space that increases with squatting
E. Diastolic murmur that is harsh and low-pitched near the third right intercostal space

Answer and topic summary

The answer is A. Early diastolic blowing murmur best heard at the left sternal border

Aortic regurgitation (AR) is a valvular heart disease defined by inadequate closure of the aortic valve. It leads to reflux of blood from the aorta into the LV during diastole. Etiologies for acute AR include bacterial endocarditis or aortic dissection; etiologies of chronic AR include rheumatic fever, connective tissue disorders (like Marfan), or bicuspid valve. On physical exam, you may hear a high-pitched, blowing, early diastolic murmur at the left sternal border. An echocardiogram is the best diagnostic tool. For those who are symptomatic or who have critically reduced LV function, surgery is warranted.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Cardiology ⇒ Valvular Disorders ⇒ Aortic regurgitation

Also covered as part of the Emergency Medicine EOR topic lists

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