BOF: 2.3
A 70-year-old male presents with a history of syncope. On
examination he has a pulse rate of 60 beats per minute, small volume, slow
rising. His jugular venous pressure is not elevated, apex beat is at the 5th
left intercostal space, mid-clavicular line, heaving in nature. The second
heart sound is single, there is an ejection systolic click and there is a
harsh loud, ejection systolic murmur radiating to the neck.
In this patient which of the following physical signs
relates to the severity of the lesion?
a)
Heaving apex beat
b)
Presence of an ejection click
c)
Intensity (loudness) of the murmur
d)
Duration of the murmur
e)
Radiation of the murmur into the neck
Answer:
a)
The history and physical signs suggest the patient has
aortic stenosis
. A heaving apex beat suggests that the heart is contracting against
resistance. This indicates that the degree of stenosis is severe. An ejection
click reflects thickening of the valve or dilatation of the aorta and is not
an indicator of severity of stenosis. Loudness and duration of the murmur bear
no relationship to the degree of stenosis. Similarly radiation of the murmur
to the neck does not bear a relationship to the degree of stenosis.
Aortic Stenosis
