A patient with aortic regurgitation typically presents with which murmur and hemodynamic finding?

• A. Late systolic murmur; narrow pulse pressure
• B. Holosystolic murmur; normal pulse pressure
• C. Continuous murmur; decreased pulse pressure
• D. Early diastolic, decrescendo murmur; widened pulse pressure

Answer: (D)

Aortic regurgitation causes blood to flow backward from the aorta into the left ventricle during diastole. This diastolic runoff lowers the aortic diastolic pressure, while the left ventricle responds to the increased volume by ejecting a larger stroke volume, which can raise the systolic pressure. The combination produces a widened pulse pressure and a characteristic early diastolic, decrescendo murmur as the aorta’s pressure drops rapidly when regurgitation begins and then eases.

The murmur is best heard at the left sternal border with the patient leaning forward, and it is often described as blowing and high-pitched. Bounding, forceful pulses may accompany the widened pulse pressure due to the increased stroke volume and rapid pressure changes.

Other murmur descriptions fit different valvular lesions and their hemodynamics (for example, late systolic or holosystolic murmurs or a continuous murmur), so they don’t align with the typical pattern seen in aortic regurgitation.