new_n_lost
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A 58-year-old man with fainting spells and exercise intolerance is found to have a bicuspid aortic valve with marked aortic stenosis.
Which of the following physical findings would be prominent in this patient?
A. Diastolic murmur
B. Heave at left parasternal border
C. Loud S2 heart sound
D. Loud S3 heart sound
E. Weak peripheral pulse
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| doc179
Forum Guru
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E
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| Luckyall
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okay these pts with congenital bicuspid Ao valve could have Pulsus tardus & parvus and if anything they will have S4, not S3, not a Diast murmur, but a big time Systolic one, Right sternal border with radiation into carotid art.
S3 i excluded it bc is due to vol. overloaded LV
Loud S2...hmmm i think is likely in HTN
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| new_n_lost
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The correct answer is E.
Flow across the aortic valve is very slow and turbulent in aortic stenosis. Consequently, aortic pressure rises slowly, and peripheral pulses are of low amplitude. The flow murmur across the aortic valve is heard during systole.
Diastolic murmurs (choice A) are a consequence of turbulence during ventricular filling, such as in mitral stenosis or aortic incompetence. Classically, aortic stenosis is associated with a midsystolic murmur.
Heaves are due to ventricular hypertrophy, and a left parasternal heave (choice B) indicates right ventricular hypertrophy. Aortic stenosis produces left ventricular hypertrophy, and thus a sustained apical heave is felt.
The S2 heart sound (choice C) is produced when the aortic valve snaps shut. S2 is soft in aortic stenosis because of the decreased arterial pressures and the intrinsically poor mobility of the aortic valve.
The S3 heart sound (choice D) is associated with rapid ventricular filling, and may occur either in mitral incompetence or congestive heart failure. No extra heart sound is heard in aortic stenosis.
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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