2025 – PAGE 127 – CARDIOLOGY

2025 – Core Study Guide 05 – Cardiology 2025 – PAGE 127 – CARDIOLOGY

AORTIC REGURGITATION/INSUFFICIENCY (AR OR AI)

Aortic regurgitation (AKA aortic insufficiency) results in a “relative mitral stenosis” from the jet of blood going backwards and hitting the mitral valve. This causes an APICAL, early-diastolic murmur. (Low yield: there may also be a mid-diastolic murmur called an Austin Flint murmur.) The physical exam reveals BOUNDING PULSES (like a PATENT DUCTUS ARTERIOUS/PDA) and the apical early-diastolic murmur. Aortic regurgi­ta­­tion is associated with MARFAN SYNDROME.

RIGHT UPPER STERNAL BORDER (RUSB) MURMURS

  • Aortic Stenosis
  • Some hypertrophic obstructive cardiomyopathy (HOCM); mid-systolic, laterally-displaced PMI, increases with Valsalva.

LEFT UPPER STERNAL BORDER (LUSB) MURMURS

The following are left upper sternal border (LUSB) murmurs:

  • Atrial Septal Defect (ASD): parasternal heave, mid-systolic
  • Pulmonary Stenosis (PS): harsh, single S1, ejection click, wide S2 split

LEFT LOWER STERNAL BORDER (LLSB) MURMURS

LEFT LOWER STERNAL BORDER (LLSB) murmurs include:

  • Ventricular Septal Defects (VSD): holosystolic
  • Still’s Murmur: buzzing/musical, mid-systolic, non-radiating, up to III/VI, benign, possibly at apex, dimi­ni­shes with standing
  • Hypertrophic Cardiomyopathy (HOCM): Laterally-displaced PMI, mid-systolic, increases with Valsalva
  • Tricuspid Stenosis: Mid-diastolic, associated with Rheumatic Fever

LEFT SUBCLAVICULAR MURMURS

  • Patent Ductus Arteriosus (PDA): continuous

APICAL MURMURS

Apical murmurs include:

  • Mitral stenosis: Mid-diastolic, associated with Rheumatic Fever
  • Mitral regurgitation: Holosystolic and associated with Marfan Syndrome and Ehlers-Danlos
  • Aortic regurgitation (AKA aortic insufficiency): early-diastolic murmur resembling MS, BOUNDING pulses

HOLOSYSTOLIC MURMURS

Holosystolic murmurs include Ventricular Septal Defects (VSDs) and Mitral Regurgitation (MR).

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