Valvular insufficiency (regurgitation) Quiz: Ace Your Exams

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A 48-year-old woman presents for follow-up to the cardiology clinic after being referred for valvular disease found on echocardiogram. She recently established care with a primary care physician after not seeing a physician for twenty years. An echocardiogram was done after the patient stated she has been experiencing significant dyspnea on exertion. The echocardiogram revealed significantly elevated pulmonary artery pressures and right ventricular hypertrophy. Vital signs are within normal limits. On physical exam, the patient is well-appearing. The lungs are clear to auscultation bilaterally. Cardiac examination reveals a split S2. An in-office electrocardiogram is performed and shows signs of right ventricular hypertrophy. Which of the following additional abnormal sounds is most likely to be heard on cardiac auscultation?

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High-pitched scratchy sound at the left lower sternal border

Blowing decrescendo early diastolic murmur at the right 2^nd intercostal space, S3 heart sound

High-frequency decrescendo murmur at the left 2^nd intercostal space, louder with inspiration

Holosystolic murmur at the left 4^th intercostal space, louder with inspiration

Blowing holosystolic high-pitched murmur at the left 5^th intercostal space, midclavicular line