Monday, August 29, 2016

Murmurs

A 23-year-old intravenous heroin user is brought to the emergency department by ambulance after being found unresponsive. The patient is resuscitated with naloxone and is admitted to the hospital, where he has a fever of 39°C (102.2°F). Upon examination, a "blowing" systolic heart murmur is heard best at the lower sternal border. The murmur varies with respiration, becoming louder with inspiration. Additionally, the examiner notes a prominent jugular venous pulse.
Which of the following valve abnormalities is most consistent with the murmur heard in this patient?

A. Aortic regurgitation
B. Aortic stenosis
C. Mitral regurgitation
D. Mitral stenosis
E. Tricuspid regurgitation
F. Tricuspid stenosis

Important clues in Step 1 questions about heart murmurs include when the murmur is heard, if it changes with inspiration of air, and where it is best heard.