Which valve lesion is typically associated with a murmur best heard at the base of the heart and radiating to the neck?

Which valve lesion is typically associated with a murmur best heard at the base of the heart and radiating to the neck?

• A. Aortic stenosis
• B. Aortic regurgitation
• C. Mitral valve prolapse
• D. Pulmonary stenosis

Answer: (A)

Radiation pattern and where a murmur is heard tell you about which valve is affected. A systolic, harsh, crescendo–decrescendo murmur best heard at the right upper sternal border (the base) that radiates up to the neck (carotids) is classic for aortic stenosis. This happens because the narrowed aortic valve creates a high-velocity jet during systole, and the flow tends to transmit to the carotid arteries, producing the neck radiation. Other valves don’t fit this pattern: aortic regurgitation is a diastolic murmur best heard along the left sternal border with different radiation; mitral valve prolapse produces a midsystolic click with a late, soft murmur at the apex; pulmonary stenosis is best heard at the left upper sternal border and may radiate to the back, not toward the neck.

Radiation pattern and where a murmur is heard tell you about which valve is affected. A systolic, harsh, crescendo–decrescendo murmur best heard at the right upper sternal border (the base) that radiates up to the neck (carotids) is classic for aortic stenosis. This happens because the narrowed aortic valve creates a high-velocity jet during systole, and the flow tends to transmit to the carotid arteries, producing the neck radiation.

Other valves don’t fit this pattern: aortic regurgitation is a diastolic murmur best heard along the left sternal border with different radiation; mitral valve prolapse produces a midsystolic click with a late, soft murmur at the apex; pulmonary stenosis is best heard at the left upper sternal border and may radiate to the back, not toward the neck.