Cardiovascular Video Quiz #2
This is a 33 year-old female with a history of infectious endocarditis with methacillin-resistant Staphylococcus aureus involving the tricuspid valve. Video 1 shows the physical exam findings. Video 2 shows the transthoracic echocardiogram of the tricuspid valve. Based on these findings the patient most likely has which of the following findings on cardiac ausculation?
A) Blowing diastolic decrescendo murmur with Austin-Flint murmur
B) Blowing holosystolic murmur radiating to the apex
C) Blowing holosystolic murmur radiating to the axilla
D) Crescendo-decrescendo systolic murmur that increases with maneuvers that decrease venous return
E) Crescendo-decrescendo systolic murmur that increases with maneuvers that increase venous return
F) Holosystolic murmur that increases on expiration
G) Holosystolic murmur that increases on inspiration
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Answer:
The patient has severe tricuspid insufficiency secondary to acute infective endocarditis. The classic murmur is a holosystolic murmur heard best on the left lower sternal border that increases on inspiration. (Choice G)
Video 1 shows the physical exam findings of giant systolic pulsations (prominant merged C-V waves).
Video 2 shows severe tricuspid valve regurgitation on the transthoracic echocardiogram.
Video source: NEJMvideos