What is the murmur description for acute severe aortic regurgitation?

• A. Early diastolic decrescendo murmur best heard along the left sternal border.
• B. Holosystolic murmur at the apex radiating to the axilla.
• C. Systolic crescendo-decrescendo murmur at the right upper sternal border.
• D. Continuous murmur best heard at the left sternal border.

Answer: (A)

Acute severe aortic regurgitation produces a high-velocity jet of blood leaking from the aorta into the left ventricle during diastole. This creates an early diastolic murmur—begins right after S2 and has a blowing, decrescendo quality as diastolic pressures equalize. It is best heard along the left sternal border (often at the third or fourth intercostal space) and is clearer when the patient leans forward and exhales to accentuate diastolic sounds. The other murmur patterns point to different conditions: a holosystolic murmur at the apex radiating to the axilla suggests mitral regurgitation; a systolic crescendo–decrescendo murmur at the right upper sternal border indicates aortic stenosis; and a continuous murmur at the left sternal border is typical of a PDA. Thus, the described early diastolic decrescendo murmur at the left sternal border is the hallmark for acute severe AR.