54-Year-Old Female with a Defective Heart Valve
Dr. El-Sheikh is a 54-year-old Egyptian female who complains of weakness, fatigue, shortness of breath, chest pain, and dizziness. Her heart rate is 96 beats/min, and her blood pressure is 148/54 mm Hg. You notice that she nods her head with every heartbeat, and her radial pulse is very strong and abrupt. Her heart sounds are abnormal, with a long diastolic murmur at the right sternal margin in the second intercostal space.
Her doctor orders an echocardiogram, which shows that Dr. El-Sheikh has severe aortic regurgitation (backflow of blood through an incompetent valve) and an enlarged left ventricle.
1. Why does an incompetent aortic valve cause a diastolic murmur?
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