A 55-Year-Old Man With a Bicuspid Aortic Valve: Osmosis USMLE Study Question

February 07, 2020

A high-frequency "blowing" diastolic murmur is classically associated with aortic regurgitation, a diagnosis that is further supported by the history of bicuspid aortic valve. Aortic regurgitation is commonly asymptomatic, with patients developing symptoms such as exertional dyspnea and other signs of heart failure (eg, angina, orthopnea, paroxysmal nocturnal dyspnea, pulmonary edema) late in the disease.

The hemodynamic abnormalities of this condition result from inadequate closure of the aortic valve. During diastole, some retrograde flow from the aorta back to the left ventricle occurs, resulting in decreased diastolic pressure. Initially, the heart compensates well for the regurgitant lesion by increasing stroke volume, leading to increased systolic pressure. Thus, aortic regurgitation is characterized by decreased diastolic pressure, increased systolic pressure, and widened pulse pressure. This wide pulse pressure can cause other findings, such as bounding pulses and head bobbing in conjunction with each heartbeat.

Major Takeaway: Aortic regurgitation causes decreased diastolic pressure and increased systolic pressure, resulting in a widened pulse pressure. Patients are often asymptomatic and typically present with an early diastolic murmur that is "blowing" in character.

Read more about aortic regurgitation.

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