A 59-year-old man presents for a well person check. A cardiovascular, respiratory, gastrointestinal and neurological examination is performed. No significant findings are found, except during auscultation a mid systolic click followed by a late systolic murmur is heard at the apex. The patient denies any symptoms. The most likely diagnosis is:
1) Barlow syndrome
2) Austin Flint murmur
3) Patent ductus arteriosus
4) Graham Steell murmur
5) Carey Coombs murmur
View Explanation
This patient is suffering from a mitral valve prolapse (Barlow syndrome, click murmur syndrome) (A). A mid-systolic click followed by a late systolic murmur is heard at the apex as the thickened mitral valve leaflet is displaced into the left atrium during systole. An Austin Flint murmur (B) produces a low pitched, mid-diastolic rumble at the apex. Classically, mitral valve displacement as well as aortic turbulence due to regurgitation qualifies as an Austin Flint murmur. A patent ductus arteriosus © produces a constant machinery murmur. A Graham Steell murmur (D) is typically heard best at the left sternal edge, second intercostals space during inspiration. A high pitched early diastolic murmur is heard associated with pulmonary hypertension. A Carey Coombs murmur (E) is a short, mid-diastolic rumble heard best at the apex due to turbulent blood flow over a thickened mitral valve, most often due to rheumatic fever.