A patient is admitted with pneumonia. A murmur is heard on examination. What finding points to mitral regurgitation?
- Murmur louder on inspiration
2) Murmur louder with patient in left lateral position - Murmur louder over the right 2nd intercostal space midclavicular line
- Corrigan’s sign
- Narrow pulse pressure
View Explanation
A murmur heard loudest on inspiration (A) points to a right-sided valve lesion. The right intercostal space midclavicular line © is the anatomical landmark for the aortic valve. The mitral area is over the apex. A murmur louder with the patient in the left lateral position (B) (as opposed to leaning forward) is associated with mitral lesions. If heard, you should determine whether the murmur radiates to the axilla. Corrigan’s sign (D) (visibly exaggerated pulsating carotids) is one of the many signs of a hyperdynamic circulation associated with aortic regurgitation (including de Mussets, Traubes, Quinkes, Duroziez and a whole host of others). A narrow pulse pressure (E) is a sign of aortic stenosis.