A 62-year-old man has a collapsing pulse with a pulse pressure of 190/55 mmHg and a high-pitched blowing early diastolic murmur along the left sternal border. At the apex there is a soft mid-diastolic rumble. The apical rumble most likely represents:
- A Rheumatic mitral stenosis with fused commissures
- B The Austin Flint murmur produced by the regurgitant jet striking the anterior mitral leaflet ✓
- C A left atrial myxoma obstructing the mitral orifice
- D Carey Coombs murmur of acute rheumatic carditis
Correct answer: B. The Austin Flint murmur produced by the regurgitant jet striking the anterior mitral leaflet
Explanation
In severe chronic aortic regurgitation, the regurgitant stream impinges on the anterior leaflet of the mitral valve during diastole, producing a low pitched mid-diastolic rumble termed the Austin Flint murmur. Unlike true mitral stenosis there is no loud S1 or opening snap, and the rumble disappears when the aortic lesion is corrected. Carey Coombs occurs in acute rheumatic fever with active carditis, not here.
Reference: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 12th ed.
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Written and medically reviewed by the StethoPrep medical team.