A lady presents with complaints of dysnea. Pulse rate is 70/min while BP=110/70 mm Hg. On examination there is an early-diastolic murmur. CXR is given here. Diagnosis of the patient is?
**Core Concept**
Early-diastolic murmurs are caused by turbulent blood flow during diastole, typically due to **aortic regurgitation** (AR) or **pulmonic regurgitation**. AR is characterized by a high-pitched, decrescendo murmur best heard at the left sternal border. Clinical signs include widened pulse pressure, a bisferiens pulse, and a "boot-shaped" heart on CXR from left ventricular hypertrophy.
**Why the Correct Answer is Right**
Aortic regurgitation causes a **high-pitched early-diastolic murmur** due to backflow of blood into the left ventricle during diastole. The widened pulse pressure (110/70 mmHg) and potential CXR findings (e.g., left ventricular enlargement, aortic root dilation) align with AR. The murmur worsens with valsalva maneuver and is often associated with a sighing quality.
**Why Each Wrong Option is Incorrect**
**Option A:** Mitral stenosis produces a **mid-diastolic rumble** with an opening snap, not early-diastolic.
**Option B:** Aortic stenosis causes a **systolic ejection murmur**, not diastolic.
**Option C:** Tricuspid regurgitation is a **holo-systolic murmur** heard best at the left sternal border.
**Clinical Pearl / High-Yield Fact**
Remember the **"diastolic trinity":**
1. Aortic regurgitation (early-diastolic)
2. Mitral stenosis (mid-diastolic)
3. Pulmonic regurgitation (late-diastolic).
Early-diastolic murmurs are high-pitched and often associated with widened pulse pressure.
**Correct Answer: C. Aortic Regurgitation**