A 28-year-old man presents with exertional dyspnoea. Pulse is 110/min, collapsing in character, with a wide pulse pressure. There are visible capillary pulsations in the nail beds and a booming sound over the femoral artery on light compression. Auscultation reveals a high-pitched early diastolic murmur at the left sternal border and a soft mid-diastolic rumble at the apex. The apical rumble is best explained by:

• A Rheumatic mitral stenosis
• B Carey Coombs murmur of acute rheumatic fever
• C Left atrial myxoma
• D Austin Flint murmur due to aortic regurgitation ✓

Explanation

The peripheral signs (water-hammer pulse, Quincke pulses, Traube sign) indicate chronic severe aortic regurgitation. Regurgitant flow strikes the anterior mitral leaflet, producing vibration heard as a mid-diastolic rumble at the apex: the Austin Flint murmur. It lacks an opening snap and loud first heart sound, which distinguishes it from true mitral stenosis, and there is no fever or cardiitis to suggest Carey Coombs.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.