Question

All of the following murmurs may be heard in patients with aortic regurgitation except:

• A. High-pitched decrescendo diastolic murmur.
• B. Soft, low pitched mid-diastolic rumbling murmur.
• C. Mid-systolic ejection flow murmur.
• D. Pansystolic murmur.

Hint:

AR gives a diastolic murmur plus, at most, a short systolic flow murmur, never a full pansystolic murmur.

Answer 1

The Correct Option is D

Aortic regurgitation lets blood leak back into the left ventricle during diastole, and this leak can produce more than one type of murmur, so it helps to go through each option.

1. High-pitched decrescendo diastolic murmur: this is the murmur made directly by the leaking blood rushing back through the aortic valve, and it is the hallmark sound of AR.
2. Soft, low pitched mid-diastolic rumbling murmur: this is the Austin Flint murmur. The jet of regurgitant blood strikes the anterior leaflet of the mitral valve, making it flutter and creating a soft rumble that mimics mitral stenosis, so it is a recognized part of severe AR.
3. Mid-systolic ejection flow murmur: because the left ventricle has to eject a much bigger volume with each beat, blood crosses the aortic valve fast enough to make a flow murmur in systole, even when the valve itself is not narrowed.
4. Pansystolic murmur: a pansystolic murmur means the sound spans the whole of systole with a fairly constant pressure gradient, which is the signature of mitral regurgitation, tricuspid regurgitation, or a ventricular septal defect. AR's own murmur is diastolic, and its systolic murmur is only a brief flow murmur, so a true pansystolic murmur does not belong to AR.

Three of the options describe sounds that genuinely occur in AR, while the pansystolic murmur belongs to a different set of valve lesions entirely.

Let's summarize:

• AR produces a diastolic decrescendo murmur, sometimes an Austin Flint rumble, and sometimes a short systolic flow murmur.
• A pansystolic murmur points to mitral regurgitation, tricuspid regurgitation, or a VSD, not AR.

So the exception is the pansystolic murmur.