Aortic stenosis and aortic regurgitation.
In today’s clinical skills session, we had an opportunity to perform a cardiovascular exam on a symptomatic patient. The result of which was a bit of detective work. We went through an informal history taking session and then proceeded to the inspection, percussion and palpation.
Upon auscultation, it was immediately evident that the heart sounded different. All those times the doctors said to focus and know the normal were spot on. It definitely did not sound like the regular volunteer patients we had. There was a slight systolic and prominent diastolic component to the murmurs that was loudest in the second intercostal space to the right of the sternal border, where the aortic valve was.
The patient also had an unusually strong pulse, with an upstroke almost as though it was leaping up to meet your finger and a downstroke disappearing just as fast. We found out later it is what’s called a collapsing pulse. This occurs in aortic regurgitation, where the aortic valve doesn’t close properly. The pulse is momentarily strong, but then disappears due to blood rushing back through the aortic valve into the left ventricle, dropping blood pressure sharply. The diastolic murmurs were a result of this regurgitated blood.
All in all, it was a very engaging and interactive learning experience.