In patients with a barely audible diastolic murmur and heart failure, what sign is suggestive that severe AR is the cause of the heart failure?
a. A third heart sound
b. A murmur of functional MR
c. An increased second heart sound
d. A BP of 130/45 mmHg
e. A decreased first heart sound
Answer d:
In patients with heart failure of any cause, an S3, a murmur of functional MR and a soft S1 are commonly observed. An increased S2 is unrelated to the degree of MR. Persistent peripheral signs of AR despite the heart failure, such as bounding arteries, increased BP, differential and decreased diastolic pressure, are particularly suggestive of severe AR.
a. A third heart sound
b. A murmur of functional MR
c. An increased second heart sound
d. A BP of 130/45 mmHg
e. A decreased first heart sound
Answer d:
In patients with heart failure of any cause, an S3, a murmur of functional MR and a soft S1 are commonly observed. An increased S2 is unrelated to the degree of MR. Persistent peripheral signs of AR despite the heart failure, such as bounding arteries, increased BP, differential and decreased diastolic pressure, are particularly suggestive of severe AR.
