Q:

A 47-year-old male with fatigue and cardiac failure has a high-pitched, decrescendo diastolic murmur along the left sternal border and an apical diastolci rumble. His blood pressure is 148/45 mmHg. The following is/are true:

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A 47-year-old male with fatigue and cardiac failure has a high-pitched, decrescendo diastolic murmur along the left sternal border and an apical diastolci rumble. His blood pressure is 148/45 mmHg. The following is/are true:


  1. Chest radiograph will show cor bovinum
  2. The apical murmur is due to the Gallavardin phenomenon
  3. A carotid shudder would be expected
  4. Abdominal exam will show a pulsatile liver

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a. Chest radiograph will show cor bovinum

This patient with aortic insufficiency has a volume loading strain on the heart which produces cor bovinum as dramatic enlargement. The apical murmur produced by turbulence with mitral forward flow mimics mitral stenosis and is called an Austin-Glint murmur. A carotid shudder occurs with aortic stenosis and a pulsatile liver is typical of tricuspid insufficiency. 

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