RuMi
Forum Newbie
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A 50-year-old man has a 10-year history of poorly controlled hypertension. Vital signs are:
Pulse 96/min
Respirations 16/min
Blood pressure
Left arm 226/120 mm Hg
Right arm 218/118 mm Hg
With the patient in the left lateral decubitus position, a late diastolic sound is heard best with the bell at the apex. Which of the following is the most likely explanation for this auscultatory finding?
A) Aortic insufficiency
B) Aortic stenosis
C) Mitral insufficiency
D) Mitral stenosis
E) Opening snap
F) Pulmonic insufficiency
G) Pulmonic stenosis
H) S3
I) S4
J) Tricuspid insufficiency
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| adeelmd
Forum Elite
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a... just look at the pulse pressure difference... gives it away...
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| RuMi
Forum Newbie
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but arent aortic murmurs only heard at the 2nd intercostal space to the right of the sternum? an aortic murmur heard at the apex doesnt make sense to me. :?:
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| adeelmd
Forum Elite
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i'm not too sure.. murmurs can be mysterious as to where they can be heard sometimes... but a mitral regurg would not have such a high pulse pressure.... think about it, it's pumping some of it's blood into the left atrium, and some to the aorta.. so it couldn't have such a high development in pulse pressure.. Actually, when you think about blood rushing back into the left ventricle in a regurg, you can kinda of imagine why a murmer could be heard there....
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| scion
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aortic insufficiency.
1) Aortic insufficiency not rare with uncontrolled hypertension.
2) Aortic murmur can transmit to apex.
3) Blood from aortic regurg can lift anterior mitrovalve causing mitrovalve "stenosis".
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| xfwang2002
Forum Junior
Topics: 8
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It is S4 because the patient has hypertrophy LV
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