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

Step 1: Understanding the Question.
Aortic regurgitation (AR) is leakage of blood back into the left ventricle during diastole because the aortic valve does not close properly. The question asks which murmur is NOT a feature of AR.

Step 2: Key Concept.
AR itself produces a high-pitched early diastolic decrescendo murmur from the regurgitant jet. Two other murmurs can accompany it: the Austin Flint murmur, a soft low-pitched mid-diastolic rumble at the apex caused by the regurgitant jet hitting the anterior mitral leaflet, and a systolic ejection flow murmur caused by the large stroke volume crossing the aortic valve.

Step 3: Detailed Explanation.
Option (1) high-pitched decrescendo diastolic murmur: this is the direct murmur of AR itself, heard best at the left sternal border with the patient leaning forward, so it is present in AR.
Option (2) soft, low pitched mid-diastolic rumbling murmur: this is the Austin Flint murmur, a well-known accompaniment of significant AR, so it is present in AR.
Option (3) mid-systolic ejection flow murmur: the extra volume of blood ejected through the aortic valve each beat can create a systolic flow murmur even without true valve narrowing, so it is present in AR.
Option (4) pansystolic murmur: a pansystolic, or holosystolic, murmur is the murmur of mitral regurgitation, tricuspid regurgitation, or a ventricular septal defect, where there is a pressure gradient across the whole of systole. AR does not produce a pansystolic murmur, since its murmur is diastolic, and its systolic component is only a short ejection flow murmur, not a holosystolic one.

Step 4: Final Answer.
The pansystolic murmur is the one not heard in aortic regurgitation.
\[ \boxed{\text{Pansystolic murmur}} \]