Rosh Pediatrics Practice Exam

What type of heart murmur is typically associated with rheumatic heart disease and mitral regurgitation?

1. Harsh, machine-like continuous murmur at the left upper sternal border

2. High-pitched holosystolic murmur at the apex with radiation to the axilla

3. Musical, soft, vibratory low-pitched systolic murmur over the left lower sternal border

4. Systolic ejection murmur at the left upper sternal border

The correct answer is: High-pitched holosystolic murmur at the apex with radiation to the axilla

The high-pitched holosystolic murmur at the apex with radiation to the axilla is characteristic of mitral regurgitation, which frequently results from rheumatic heart disease. In this condition, the mitral valve may become incompetent, allowing blood to flow backward from the left ventricle into the left atrium during systole. This type of murmur is described as holosystolic or pansystolic because it occurs throughout the entire duration of systole, from the first heart sound to the second, without a gap. Such a murmur is typically best heard at the apex of the heart, which is located at the left fifth intercostal space along the midclavicular line. The radiation of the sound to the axilla is a hallmark feature of mitral regurgitation murmurs, helping differentiate them from other types of murmurs. Understanding these acoustic properties is critical for the diagnosis and management of conditions such as rheumatic heart disease, where the mitral valve can be affected due to a prior streptococcal infection. Other types of murmurs presented do not align with the typical presentation of mitral regurgitation associated with rheumatic heart disease. Harsh, machine-like continuous murmurs often indicate