Rosh Internal Medicine Boost Practice Exam

What is the typical finding in a patient suspected of aortic stenosis on examination?

1. Crescendo-decrescendo murmur

2. Harsh midsystolic ejection murmur

3. Pansystolic murmur

4. Early diastolic murmur

The correct answer is: Harsh midsystolic ejection murmur

In the case of aortic stenosis, the typical finding on examination is a harsh midsystolic ejection murmur. This murmur arises due to the turbulent blood flow across the narrowed aortic valve during systole. The harsh quality is indicative of the high-velocity jet of blood as it is forced through the stenosed valve, and it often radiates to the carotid arteries. The classic description of this murmur is a systolic ejection type, which means it begins after the first heart sound (S1) and resolves before the second heart sound (S2). The sound generally has a "crescendo-decrescendo" pattern, which also signifies that the intensity increases and then decreases during the duration of systole. This is a characteristic feature of aortic stenosis. In contrast, other types of murmurs mentioned, such as a pansystolic murmur, typically indicate conditions such as mitral regurgitation or tricuspid regurgitation, where there is a continuous backflow of blood throughout systole. An early diastolic murmur is seen in conditions like aortic regurgitation, where the abnormal flow occurs during the relaxation phase of the heart. Therefore, the distinguishing feature of aortic