A middle-aged patient with a crescendo-decrescendo systolic murmur best heard at the right upper sternal border radiating to the carotids is most consistent with which diagnosis?

A middle-aged patient with a crescendo-decrescendo systolic murmur best heard at the right upper sternal border radiating to the carotids is most consistent with which diagnosis?

• A. Severe aortic stenosis due to congenital bicuspid aortic valve
• B. Aortic regurgitation/insufficiency
• C. Mitral stenosis
• D. Tricuspid regurgitation/insufficiency

Answer: (A)

The crescendo-decrescendo systolic murmur heard best at the right upper sternal border with radiation to the carotids is classic for aortic stenosis. This murmur pattern reflects turbulent blood flow across a narrowed aortic valve during left ventricular systole. In middle age, severe AS often stems from a congenitally bicuspid aortic valve, which predisposes to earlier calcific obstruction compared with a normal tricuspid valve. The radiation to the carotids occurs because the high-velocity jet through the stenotic valve projects toward the carotid arteries. This presentation distinguishes it from other valvular diseases: aortic regurgitation produces a diastolic decrescendo murmur, mitral stenosis has a diastolic murmur with an opening snap at the apex, and tricuspid regurg is a holosystolic murmur at the left lower sternal border.

The crescendo-decrescendo systolic murmur heard best at the right upper sternal border with radiation to the carotids is classic for aortic stenosis. This murmur pattern reflects turbulent blood flow across a narrowed aortic valve during left ventricular systole. In middle age, severe AS often stems from a congenitally bicuspid aortic valve, which predisposes to earlier calcific obstruction compared with a normal tricuspid valve. The radiation to the carotids occurs because the high-velocity jet through the stenotic valve projects toward the carotid arteries. This presentation distinguishes it from other valvular diseases: aortic regurgitation produces a diastolic decrescendo murmur, mitral stenosis has a diastolic murmur with an opening snap at the apex, and tricuspid regurg is a holosystolic murmur at the left lower sternal border.