Forty year old person with ESM and EDM – Medicine MCQ – CVS – Answer

Forty year old person with ESM and EDM – Medicine MCQ – CVS – Answer

Forty year old person is found to have an ejection systolic murmur (ESM) and early diastolic murmur (EDM) at the left sternal border. Character of his pulse is likely to be – Correct answer: b) Bisferiens pulse

Ejection systolic murmur and early diastolic murmur at the left sternal border can occur in aortic regurgitation with aortic stenosis or severe aortic regurgitation with an additional systolic flow murmur. The combination can also occur in pulmonary stenosis with regurgitation. But that combination is unlikely to produce any characteristic pattern of pulse.

Bisferiens pulse can occur in a combination of aortic stenosis with regurgitation as well as in severe aortic regurgitation. It has two peaks in systole.

Other types of pulses

Slow rising pulse (pulsus parvus et tardus – low volume and slow rising) is seen in isolated severe aortic stenosis. Pulsus paradoxus is seen in cardiac tamponade and obstructive lung disease with wide swings in intrathoracic pressure during respiration.  Pulsus alternans is seen in left ventricular failure. Dicrotic pulse which may be seen in heart failure has one systolic and another diastolic peak.

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